Scrotal Hematoma – 3 Symptoms, Important Risk factors, Prognosis, Effective Treatment

What is Scrotal Hematoma?

• Scrotal hematoma is a collection of blood inside the scrotum.
• The scrotum is the sac that contains the testicles, blood vessels, and structures that help deliver sperm and semen.
• A scrotal hematoma can develop after even a minor injury or a minor procedure such as a vasectomy.

What are the causes?

• A hematoma occurs when blood leaks out of a damaged blood vessel.
• When blood leaks, it can collect and cause swelling.
• This can happen after an injury or surgery.

What increases the risk of Scrotal Hematoma?

You are more likely to develop this condition if:

• You have injured your scrotum.
• You recently had a scrotal surgery or any other procedure in the scrotum, such as a vasectomy or vasectomy reversal.
• You do not protect your scrotum during athletic activities.

What are the symptoms of Scrotal Hematoma?

The symptoms of a scrotal hematoma can vary depending on the severity of the bleeding and the underlying cause. Common symptoms include:

1. Scrotal Swelling: The most noticeable symptom is swelling of the scrotum. The scrotum may appear larger than usual and feel tense or firm to the touch.
2. Pain and Discomfort: Hematomas can cause varying degrees of pain or discomfort in the scrotum. The pain may range from mild to severe and can be exacerbated by movement or touch.
3. Discoloration: The skin over the scrotum may take on a bluish or purplish or reddish discoloration due to the accumulation of blood beneath the skin.
4. Tenderness: The scrotal area may be tender to touch or pressure.
5. Feeling of Heaviness: Some individuals with a scrotal hematoma report a sensation of heaviness or pressure in the scrotum.
6. Difficulty Walking: Severe swelling and discomfort can make it difficult to walk comfortably.
7. Localized Heat: The affected area may feel warmer than usual due to increased blood flow and inflammation.
8. Fever (In Some Cases): If the hematoma is caused by an infection, fever and signs of infection such as redness, warmth, and increased pain may be present.

What latest research says about the Scrotal Hematoma?

A case report an unusual case of acute spontaneous scrotal haematoma presenting with haemorrhagic shock requiring resuscitation.

• A 78-year-old man presented to the emergency department with a 12-hour history of sudden-onset, rapidly progressing scrotal swelling, followed by collapse. On examination, he appeared clammy (temperature: 36°C), tachycardic (heart rate: 110 bpm), and hypotensive (blood pressure: 90/60 mmHg).
• There was no history of scrotal trauma. The patient was on anticoagulation therapy for a metallic heart valve replacement; however, his admission international normalised ratio (INR) was 1.08.

• A pelvic x-ray did not show a fracture or any other bony pathology but only mild degenerative joint changes. Ultrasonography showed a large haematoma in the scrotum. Post-contrast computed tomography (CT) revealed a large (15.0cm x 12.2cm x 9.7cm) right-sided haematocoele of mixed attenuation consistent with acute haemorrhage and evidence of extravasation of contrast (sign of active bleeding) at the superior pole of the haematocoele.
• There was no evidence of any abdominal, pelvic or testicular pathology. The left testicle was displaced further laterally along with displacement of the posterior urethra. The right testicle could not be visualised on either CT or ultrasonography.
• Emergency scrotal exploration was carried out on account of an expanding tense scrotal haematoma, a significant drop in haemoglobin levels (from 12g/dl to 8g/ dl) on serial monitoring over six hours and signs of haemorrhagic shock. There was an extensive haematoma in the layers of the scrotal wall, septum and tunica vaginalis. There was minimal reactive hydrocoele of the tunica with a non-traumatised testis but considerably contused cord structures. A litre of haematoma was evacuated and an inguinal orchidectomy was performed because of the contused cord structures, thereby removing any possible or potential source of intrascrotal bleeding. Histology revealed normal cord structures, epididymis and testis with no evidence of malignancy.
• This case report also highlights that although CT can be a very useful diagnostic tool, it does have limitations. In this instance, CT suggested a right haematocoele, raising the possibility of testicular rupture, but in fact the clinical findings and histology revealed the cord structures, epididymis and testis on that side to be normal.

How is this diagnosed?

Scrotal Hematoma is diagnosed based on:

• Your medical history.
• Recent procedures you have had.
• Recent injuries you have experienced.
• A physical exam of the scrotum and surrounding area.
• An ultrasound.
• Urine tests.
• MRI Scrotum – MRI confirms the presence of a hematoma, when a prompt diagnosis is needed, by showing lesion hyperintensity on T1WI in the subacute phase, with lack of enhancement. A T2 hypointense rim may be detected on chronic hematomas, due to hemosiderin deposition. T1 hyperintensity (subacute phase), hypointense T2 rim (chronic phase), absence of enhancement
• CT can be a very useful diagnostic tool, it does have limitations. In this instance, CT suggested a right haematocoele, raising the possibility of testicular rupture, but in fact the clinical findings and histology reveals the cord structures, epididymis and testis on that side to be normal.

How is this treated?

Scrotal Hematoma may be treated by:

• Taking NSAIDs, such as aspirin or ibuprofen, to help relieve pain.
• Applying ice to the scrotum.
• Resting.

In some cases, surgery may be needed to prevent more problems with the scrotum or testicles. Surgery may also be used to check for other issues if treatment does not work.

Scrotal haematomas do not often need surgical intervention but can be managed conservatively and over time resolve spontaneously but the overwhelming clinical circumstances in our case demanded urgent surgical exploration for evacuation of haematoma and to control bleeding.

General instructions

• Monitor your hematoma and scrotum for any changes.
• If directed, put ice on the affected area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Use scrotal support, such as a jock strap or underwear with a supportive pouch.
• Keep all follow-up visits as told by your health care provider. This is important.

Follow these instructions at home:

Activity

• Rest as directed by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid sexual activity until your health care provider says that this is safe for you.
• Avoid any activities that might put pressure on the scrotum and penis, such as bicycling or horseback riding.

Contact a health care provider if:

• You have cloudy or dark urine.
• You are urinating more frequently than usual.
• Your scrotum is red or sore.
• You have a fever or chills.

Get help right away if:

• You develop pain that:
  • Gets worse.
  • Does not go away or get better with medicine.
• You have scrotal swelling that gets worse or causes pain.
• You have abdominal pain that gets worse.
• You have problems urinating, such as:
  • Difficulty starting urination.
  • Painful urination.
  • Slow flow of urine.
  • Blood in your urine.
  • Inability to urinate.
• You have redness that spreads from your scrotum into your groin or thighs.

What is the prognosis of scrotal hematoma?

The prognosis of a scrotal hematoma depends on various factors, including the underlying cause, the extent of the hematoma, and the promptness of medical intervention. Here are some general considerations:

1. Size and severity: The size and severity of the scrotal hematoma can impact the prognosis. Larger hematomas may take longer to resolve and can potentially cause more discomfort or complications.
2. Underlying cause: Identifying and addressing the underlying cause of the scrotal hematoma is crucial for determining the prognosis. Scrotal hematomas can occur due to trauma, surgery, or underlying medical conditions. If the cause is a trauma-related injury, such as a testicular rupture or fracture, the prognosis may be influenced by the extent of the injury and associated complications. If the hematoma is a result of surgery, the prognosis may depend on the success of the surgical procedure and the management of any postoperative complications.
3. Timely medical intervention: Prompt medical evaluation and appropriate intervention can contribute to a better prognosis. Timely diagnosis, treatment, and monitoring of the scrotal hematoma can help prevent complications and promote healing.
4. Complications: Complications, such as infection, abscess formation, or damage to the testicles or surrounding structures, can impact the prognosis. Timely recognition and management of complications are essential for minimizing their impact on the overall outcome.
5. Individual factors: Each individual may have unique characteristics and health conditions that can influence the prognosis of a scrotal hematoma. Factors such as age, overall health, immune function, and any pre-existing conditions can affect the body’s ability to heal and recover.

It’s important to note that the prognosis can vary significantly from case to case. While many scrotal hematomas resolve on their own with conservative management, others may require medical or surgical intervention. It’s recommended to consult with a healthcare professional, such as a urologist, who can provide a more accurate prognosis based on the specific circumstances and individual factors involved.

Summary

• Scrotal hematoma is a collection of blood inside the scrotum. The scrotum is the sac that contains the testicles, blood vessels, and structures that help deliver sperm and semen.
• A scrotal hematoma can be caused by injury to the scrotum or by a procedure, such as a vasectomy.
• Symptoms of this condition include pain and discomfort, swelling, and discoloration of the scrotum.
• This condition may be treated with rest, icing, and talking NSAIDs, such as aspirin or ibuprofen.

Sources

1. Burnand K, Viswanath S, Kumar V, Chitale S. Acute spontaneous scrotal haematoma presenting with haemorrhagic shock: a case report. Ann R Coll Surg Engl. 2012 Jan;94(1):e1-2. doi: 10.1308/003588412×13171221498785. PMID: 22524901; PMCID: PMC3954209.