Man With Groin Pain

Abstract

A 19-year-old male patient was transferred to the emergency department after a motorcycle accident. His main complaint was pain in the left groin and scrotum. He was hemodynamically stable and had a firm, movable, and tender mass over the left groin (Video E1 [available at http://www.annemergmed.com]). The testis in the left scrotum could not be palpated (Figure 1). The emergency physician performed ultrasonography that revealed normal echotexture of testis without hematoma or focal lesions (Figure 2) and confirmed the diagnosis by computed tomography (Figure 3).Figure 2Sonography of the left groin mass in the sagittal plane showed ovoid and homogeneous echogenicity, which favor a normal testis image.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Computed tomography image of the abdomen and pelvis in the axial view with intravenous contrast demonstrating dislocation of the testis over the left inguinal region.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Traumatic testicular dislocation. The patient underwent a successful manual testicular reduction in the emergency department. Unfortunately, the testicle redislocated easily, and a urologist performed successful surgical exploration and orchiopexy. Traumatic testicular dislocation is a rare complication of scrotal trauma, typically resulting from straddle injury sustained in a motorcycle collision. The most common dislocation site is the superficial inguinal region, accounting for >50% of cases. Successful manual reduction includes normal scrotal anatomic positioning and immediate pain relief. However, this may only be possible in 15% of cases given the small size of the defect in spermatic cord layers, edema of the scrotal wall, and the possibility of further testicular damage.1Tai Y.S. Chen Y. Tsai P. et al.Traumatic testicular dislocation: a rare occurrence of blunt scrotal injury.Urol Sci. 2014; 25: 158-160Abstract Full Text Full Text PDF Scopus (4) Google Scholar Surgical repair is required if manual reduction fails or there are coexisting injuries.2Subramaniam S. Ab Khalil M.K. Zakaria J. et al.Managing traumatic testicular dislocations: what we know after two centuries.BMJ Case Rep. 2020; 13e236801Crossref Scopus (3) Google Scholar,3Riaza Montes M. Palacios Ramos J. Gallego Sánchez J.A. Testicular dislocation: an atypical case and review of the literature.Urol Case Rep. 2020; 33: 101405Crossref PubMed Scopus (2) Google Scholar https://www.annemergmed.com/cms/asset/bd128463-f101-4c82-8a09-caa0deea2109/mmc1.mp4Loading ... Download .mp4 (2.74 MB) Help with .mp4 files Video E1