A boy over 10 years old was taken to Children's Hospital 2 after about 15 hours of being kicked by a friend in the scrotum area. The child's right scrotum pain gradually increased but did not have fever or vomiting. Notably, the outer scrotum area was almost not swollen, red or bruised.
At the Urology Department, Children's Hospital 2, doctors discovered that the right testicle of the child was nearly twice as large as the left and had severe pain during examination. Ultrasound showed that the structure of the testicular parenchyma and the right epidural was not consistent, suggesting internal lesions.
Based on the injury mechanism, pain progression, clinical examination and ultrasound results, BS.CKII Phan Tan Duc and BS.CKI Nguyen Thi Kim Nga, Urology Department, Children's Hospital 2, determined that the child had a right testicle injury, suspected testicle rupture and indicated emergency exploration surgery.
During the surgery, doctors recorded that the white testicle was torn, the testicle parenchyma was exposed in the middle of the right testicle. The parenchyma that was still viable was maximally preserved, and the white testicle was sewn back.
After surgery, the child's pain subsided, the condition stabilized and she was discharged from the hospital the next day. The child was scheduled for re-examination to monitor testicular function for a long time.
According to doctors, the noteworthy point in this case is that the external manifestation of the scrotum is almost normal, while internal damage has occurred.
Testicular rupture is a condition in which the protective layer surrounding the testicle is torn, causing testicular parenchyma to escape. This is a lesion that needs to be detected and treated early to maximally preserve the surviving parenchyma.
Therefore, after children are kicked, fall, hit while playing sports or have direct injuries to the genitals, parents should not just rely on the fact that the scrotum is not swollen or bruised to assess the extent of injury.
If the child still has prolonged pain or the pain gradually increases after the injury, it is necessary to take the child to the doctor early.
Signs parents need to pay attention to include prolonged testicular or scrotal pain, gradually increasing pain; one testicle or scrotum larger than the other; severe pain when touched; scrotum swelling, bruising; nausea or vomiting accompanied by scrotal pain.
Children who are uncomfortable walking, often hug or avoid the scrotum area, or have any abnormal changes in the genital area after injury also need to be checked.
Color Doppler ultrasound helps doctors assess the structure and irrigate the testicles. However, in case of suspected severe injury, doctors need to combine the injury mechanism, progression of symptoms, examination, and imaging to make treatment decisions.
When testicular rupture is identified or there is still high suspicion, early exploratory surgery may be indicated to assess the extent of damage and maximize the surviving perineum.
The goal of surgery is not only to preserve the testicles but more importantly to preserve the parenchyma that is still viable and active.
Even if conservation surgery is successful, children still need to be monitored periodically because testicles that have been injured are at risk of decreasing in size or atrophy later. Re-examination helps assess development, parenchymal structure and testicular irrigation, especially when children enter puberty.
Based on the above case, doctors recommend that parents should not be subjective when children have scrotum injuries. A scrotum that is not swollen or bruised does not mean that the testicles are not damaged.
Prolonged or gradually increasing testicular pain after injury is a sign that needs to be assessed early. Timely detection and treatment is important in preserving the parenchyma and testicular function of children in the long term.
