摩托車事故後睪丸外傷性脫位：病例報告與文獻綜述

胡蔚祥、李毅彥、歐宴泉、許兆畬、童敏哲

童綜合醫院 外科部 泌尿科

Traumatic Testicular Dislocation Following a Motorcycle Accident: A Case Report and Literature Review

Wei-Shiang Hu, Yi-Yen Lee, Yen-Chuan Ou, Jow-Yu Shu, Min-Che Tung

Division of Urology, Department of Surgery,

Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan

Case presentation

A previously healthy 19-year-old male was admitted to our facility after experiencing a motorcycle accident. The initial assessment under Advanced Trauma Life Support (ATLS) protocols revealed no life-threatening conditions. However, the secondary examination was significant for pronounced bruising in the lower abdominal and perineal areas. Palpation disclosed a tender, ovoid mass in the right inguinal region, superior and lateral to the pubic tubercle, indicative of a dislocated testis, as the right hemiscrotum appeared vacated. The left testicle was anatomically positioned within the scrotum. The patient confirmed that both testicles were typically situated prior to the trauma.

Diagnostic ultrasonography elucidated the ectopic position of the right testis, which retained normal size, with color flow Doppler imaging verifying adequate blood flow. A computed tomography (CT) scan identified a 4.5 cm ovoid soft tissue mass within the right inguinal canal, extending into the area normally occupied by the hemiscrotum, raising concerns for a concomitant scrotal hematoma in addition to testicular dislocation.

Management and Outcome

Non-invasive reduction of the dislocated testicle was unsuccessful. Consequently, the patient underwent emergency surgical exploration under general anesthesia. The intraoperative findings confirmed a viable and untwisted testicle within the superficial inguinal pouch. The testis was carefully mobilized, and a right-sided orchidopexy was executed to secure the testicle in its proper scrotal position. Postoperatively, the patient’s course was uncomplicated. He was discharged after three days with appropriate analgesia for pain management.

Discussion:

Testicular dislocation is a rare yet potentially serious consequence of blunt scrotal trauma, which is often associated with high-energy impacts such as motorcycle accidents. The condition may go underrecognized due to underreporting, with bilateral cases representing approximately a third of instances. Although most frequently resulting from significant force, dislocation can occur from seemingly minor injuries as well.

The testis may relocate to several potential sites, most commonly the superficial inguinal pouch. Contributing anatomical and physiological factors include an overactive cremasteric reflex, a dilated superficial inguinal ring, or existing testicular atrophy.

Diagnosis hinges on a meticulous physical examination, typically revealing an empty hemiscrotum and, at times, an associated tender mass. Ultrasonography with Doppler is the primary imaging modality to ascertain testicular viability and blood flow, while computed tomography can aid in locating an elusive testis.

Initial management may involve non-surgical reduction, which is contingent on early detection and the testis being reachable within the upper scrotum. Should this be ineffective, or in cases of recurrence, surgical intervention through orchidopexy is indicated.

Delayed treatment can lead to complications such as torsion and ischemia, impairing testicular function and fertility. Nevertheless, prompt and appropriate management typically results in a favorable prognosis for both endocrine and reproductive outcomes.