What is the most likely injury in a man hit in the groin with a soccer ball?

Most Likely Injury from Soccer Ball to the Groin

Testicular rupture is the most critical injury to rule out in a man struck in the groin with a soccer ball, though testicular contusion is more common. 1, 2

Understanding the Injury Pattern

Blunt scrotal trauma from sports-related impacts like a soccer ball creates a diagnostic challenge because the clinical presentation is typically homogeneous—pain and swelling—regardless of severity. 3 The key distinction is between injuries requiring urgent surgical intervention (testicular rupture) versus those managed conservatively (contusion, hematoma). 2

Why Testicular Injury is Most Likely

• Sports account for more than half of all testicular injuries, with blunt force trauma being the predominant mechanism. 3
• Testicular rupture occurs in 50% of patients with traumatic hematocele and is frequently misdiagnosed if not aggressively evaluated. 2
• The other options listed are far less likely with this mechanism:
  • Bladder rupture requires high-energy trauma and is associated with pelvic fractures in 60-90% of cases 4
  • Pelvic fracture requires substantial force, typically from motor vehicle collisions or falls from height 4
  • Penile fracture occurs during intercourse or manipulation with an erect penis, presenting with a characteristic "cracking sound" and immediate detumescence 5

Immediate Diagnostic Approach

Perform point-of-care ultrasound (POCUS) immediately to evaluate for:

• Loss of testicular contour 1
• Heterogeneous parenchyma 1
• Presence of hematocele 2

Critical Caveat

Ultrasound cannot reliably differentiate intratesticular hematoma from rupture in the majority of blunt trauma cases. 6 If imaging is equivocal or clinical suspicion remains high, proceed directly to surgical exploration. 2

Management Algorithm

If testicular rupture is suspected or confirmed:

• Prompt surgical exploration is mandatory—conservative management leads to testicular loss in 21% of cases versus only 6% with immediate exploration. 6
• Early surgical repair prevents testicular atrophy and preserves function. 2

First rule out traumatic testicular torsion:

• If testicular scanning is unavailable or equivocal, surgical exploration is indicated. 2
• Once torsion is excluded, ultrasound guides further management. 2

Key Clinical Pitfalls

• Do not rely solely on ultrasound to exclude testicular rupture—when in doubt, explore surgically. 6
• Do not manage conservatively without definitive imaging showing intact testicular architecture—this leads to significantly higher rates of testicular loss. 6
• Do not miss bilateral injury, though rare in blunt trauma (1.4%), as it can affect fertility. 6