Spermatic cord injury associated with blunt trauma

Abstract

Spermatic cord injury due to blunt trauma is an entity rarely encountered in clinical practice, and it may be mainly characterized by the onset of severe pain, swelling, or hematoma in the groin area. We present a case of a fresh spermatic cord injury caused by blunt trauma, which was correctly diagnosed after a surgical exploration. A 53-year-old healthy man had a strong blow from a handlebar on the right groin region in a motorcycle accident. He was transferred to our hospital from a rural hospital 3 hours after the accident because a hematoma was suddenly expanding in the right groin. On presentation, a 12 cm diameter painful subcutaneous hematoma of the right groin extending into the right hemiscrotum was found (Fig. 1). There was no medical history of blood dyscrasias, anticoagulant therapy, inguinal hernia, or urinary symptoms. His vital signs were normal. Contrast-enhanced computed tomographic (CT) images showed a large subcutaneous hematoma with contrast medium extravasation at the groin level and the edematous spermatic cord at the pudendal level (Fig. 2). There was no evidence of either any external iliac or femoral artery injuries. The preoperative diagnosis was a large subcutaneous hematoma bleeding from disrupted subcutaneous vessels. He was taken to the operating room for the removal of the hematoma and hemostasis 5 hours after the accident. Under satisfactory spiral anesthesia, an 8-cm diagonal incision was made over the hematoma of the right groin. A large subcutaneous hematoma as well as the contused spermatic cord was found. The cord was severely damaged at a level approximately 4 cm distal from the internal inguinal ring, and it was bleeding modestly from the internal or external cremasteric vessels. A large hematoma was contained along the distal length of spermatic cord. The vas deferens was intact. A rupture of external oblique aponeurosis and transverse fascia was found after removing the 300-g subcutaneous hematoma. A search for these layers resulted in the discovery of preperitoneal fat without any active bleeding. Based on these findings, a right orchiectomy was performed, and then, the floor of the inguinal canal was repaired by joining the edge of the internal muscle and aponeurosis of the transverse oblique muscle to the Poupart ligament. The external oblique aponeurosis was