Consequence of neglecting an epididymal hematoma

A 21-year-old male patient, presented to the emergency department with scrotal pain, swelling, and bruising to his right hemiscrotum.He reports having a violent motorcycle accident 4 hours ago.Physical examination, even if somewhat hampered by swelling, found a palpable, moderate-sized hematoma on the spermatic cord path, with a painful right testicle.The patient underwent a scrotal doppler ultrasound examination which demonstrated a right epididymis increased in size measured 52x20 mm, hyperechogenic suggesting an epididymis hematoma.The testes were symmetrical and homogenous with no evidence of testicular injury.The patient was reluctant and refused all sort of medical or surgical care.He comes back 4 days later with scrotal pain resistant to analgesic treatment (Figure 1).Another doppler ultrasound examination was requested.The right testicle was normal sized with hypoechogenic structure, but was avascular with a thin-walled hydrocele (Figure 2).A surgery has been indicated which found an epididymis expansive hematoma with necrotic testicle (Figure 3).An orchidectomy has been done.