Testicular Compartment Syndrome in a Case of Fulminant Necrotizing Orchitis

Testicular compartment syndrome (TCS) impedes the microcirculation in the testicle, resulting from increased venous resistance or an extraluminal compression that might lead to a cascade of hypoxia, ischemia, and gangrene. We report a case of fulminant necrotizing orchitis occurring in a 45-year-old immunocompetent patient in the form of TCS. The patient underwent imaging, which suggested extensive localized right testicular abscess formation, for which the patient underwent guided drainage from the abscess. Subsequently, the patient was started on culture-sensitive intravenous antibiotics. Due to the failure of conservative treatment and symptomatic deterioration, we planned scrotal exploration. Intraoperatively, we found that the testicular tissue was necrotic and completely replaced by frank pus, with an already ruptured tunica, due to higher compartmental pressure. The patient underwent a right orchidectomy. The postoperative course in the hospital was uneventful. We report that this case as TCS is rare, and all surgeons should be aware of such possibility of occurrence.