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Scrotal trauma is a spectrum of injuries that ranges from minimal scrotal
swelling to rupture of the testis with a tense, blood-filled scrotum ( Fig. 61.7A ).
Scrotal ultrasound is useful in assessing the integrity of the testicle and the
location of fluid within the scrotum ( Fig. 61.7B ). Urgent surgical evaluation
should occur, unless the testis is clearly normal and without significant
tenderness. Note that testicular torsion may present with a spurious history of
trauma and a ruptured testis has the best salvage rate when surgically repaired.
An obvious ecchymosis of the scrotal wall after trauma suggests a hematocele,
which is blood within the tunica vaginalis. Severe testicular injury can be
associated with a hematocele, an intratesticular hematoma, or a laceration or
rupture of the tunica albuginea which directly encases the testicle. Sonography
can localize and identify blood, which is more echogenic than hydrocele fluid.
Color Doppler ultrasound can also assess testicular blood flow. Scrotal
exploration is indicated if testicular rupture or laceration is present, or in cases of
large hematoceles as they heal more readily after surgical drainage. If the tunica
albuginea can be determined to be intact, no surgical intervention is necessary.

FIGURE 61.7 Rupture of testis. A: Testicular swelling and tenderness following kick to
scrotum. B: Ultrasound examination of testis—central linear sonolucent area reflects site of
testicular rupture. Surgical repair resulted in a well-preserved gonad.

If a scrotal laceration is present, it is essential that the testis and spermatic cord
be evaluated for possible injury. This may require an examination under general
anesthesia or an inguinal cord block with more severe injuries. For simple scrotal
lacerations, careful hemostasis and closure of the laceration with chromic catgut
is sufficient.
Traumatic epididymitis is local inflammation, resulting from blunt trauma to
the scrotum, which usually evolves over a few days. Short-lived, acute pain