#1139

Scrotal Hematoma Secondary to spermatic cord vessels bleeding Mimicking Testicular Torsion in a Preterm Neonate: A Case Report

T. Yeh¹, C. Huang¹, C. Laih¹

¹China Medical University Hospital, Divisions of Urology, Taichung, Taiwan

Introduction:

Testicular torsion in neonates is a rare urological condition that requires prompt diagnosis and intervention to preserve testicular viability. However, certain conditions such as scrotal hematoma can mimic the clinical presentation of torsion, posing a diagnostic challenge. Here we report a case of a newborn presenting with a scrotal swelling with suspicion of testicular torsion and was ultimately confirmed as a scrotal hematoma.

Material and methods:

A male preterm infant was delivered via cesarean section at 30+2 weeks of gestation, with a birth weight of 1310 grams. At birth, mild ecchymosis over the left hemiscrotum was observed without swelling, suggesting birth trauma-related hematoma. However, on day four, progressive swelling and discoloration of the left scrotum were noted. Bedside ultrasonography revealed absent Doppler flow and an irregular contour of the left testis, raising suspicion for testicular torsion. Given these findings, surgical exploration was performed.

Results:

A midline scrotal incision approximately 2 cm in length was made. Upon opening the tunica vaginalis, a large hematoma and organized blood clots were identified. After evacuating the hematoma, the testis appeared viable and intact. Active bleeding was noted from the spermatic artery within the spermatic cord and hemostasis was successfully achieved under microscopy. Intraoperative Doppler ultrasonography confirmed restored blood flow to the left testis. A surgical drain was placed, and postoperative recovery was uneventful. Follow-up imaging demonstrated normal testicular perfusion and morphology.