Testicular rupture is a type of testicular injury which includes testicular fracture, intratesticular hematoma, testicular avulsion and epididymal injuries. Testicular rupture occurs when there is a fracture of the tunica albuginea with extrusion of the seminiferous tissue outside the capsule ¹.

Ultrasound is the preferred initial investigation for diagnosis of testicular rupture. Surgical exploration is often indicated as well. Findings consistent with testicular rupture include ³:

• hypoechogenic and heterogeneous parenchyma
• loss of contour definition
• tunica albuginea breach

In this patient's case, there is a large hematoma surrounding the testis. There is decreased vascularity. The testis does not appear heterogeneous.

Management of testicular rupture mandates surgical exploration with excision of necrotic testicular tubules and closure of the tunica albuginea ². Early surgical exploration is recommended over conservative management due to the significantly higher rates of orchiectomy in delayed surgery.

Complications of poorly managed testicular trauma include the necessity for orchiectomy and other morbidities such as testicular atrophy and infertility ³.

Case contributed by A/Prof Pramit Phal.