Traumatic testicular dislocation and exteriorisation through penis: A case report

Abstract

Traumatic testicular dislocation is a rare consequence of blunt scrotal injury. Testicular dislocation typically results from high-energy trauma, such as motor vehicle accidents or falls, leading to dislodgement of the testicle from its normal anatomical position. We present a rare case of a young man with traumatic unilateral dislocation and exteriorisation of the testicle through a sub corona penile defect, following a high-speed motorbike accident.

1 Introduction

Traumatic testicular dislocation is a rare and often underdiagnosed injury, typically resulting from high-energy trauma. Though testicular dislocation is well-documented in trauma literature, incidents involving such atypical anatomical routes—especially through a penile defect—are exceedingly rare. Penile trauma, particularly in the form of fractures or lacerations, can sometimes be associated with significant genital injuries, including testicular dislocation. However, the combination of a sub corona penile defect with testicular exteriorisation has not been widely reported in medical literature. It is important to recognise that these types of injuries can have a delayed diagnosis due to associated severe injuries. Prompt recognition and correction of the defect is vital in preserving testicular function.

2 Case presentation

A 29-year-old male was involved in a high-speed motorbike accident, sustaining significant blunt trauma to the lower abdomen and pelvis. On presentation to the emergency department, he was alert and complained of severe pain in the genital region. On focussed assessment there was no history of undescended testiss, inguinal hernia or retractile testis. Physical examination revealed unilateral testicular dislocation, with the right testicle exteriorized through a sub corona defect in the penis ( Fig. 1 ). There were no signs of scrotal haematoma or other genital injuries aside from a superficial abrasion on the right hemi-scrotum. The defect in the penis appeared as an open wound on the right ventral portion just beneath the corona of the glans, through which the testicle had extruded. The left testis examined normal with no obvious deformity. Other injuries identified included seventh rib fracture, glade III splenic injury, left radius fracture and left femur fracture.

Initial diagnostic work-up included a bedside ultrasound scan of the scrotum, which confirmed intact vascularity of the exteriorized right testicle, with no evidence of ischemia or torsion. The ultrasound also revealed an intact tunica vaginalis and a small haematoma involving the epididymis, with no obvious signs of injury to the spermatic cord structures. No other significant pelvic injuries were detected on the CT trauma pan scan, which was conducted to assess the full extent of trauma.

Given the unusual nature of the injury, the patient was promptly taken to the operating room for surgical intervention. An indwelling urinary catheter was placed without complication, and there was no evidence of haematuria. Intraoperatively, the testicle was successfully reduced into the right hemi-scrotum, a syringe washout with normal saline through the defect was performed. There was collection of irrigation fluid within the penile shaft after washout which resolved with compression ( Fig. 2 ). The penile defect was repaired in layers, including Dartos fascia and the skin ( Fig. 3 ). A scrotal ultrasound scan was performed on day two post procedure and noted normal sonographic appearance of bilateral testes. A small right epididymal haematoma is noted.