Superficial dorsal vein rupture mimicking penile fracture

Abstract

University clinic for surgical diseases “St. Naum Ohridski” Skopje Penile trauma is a rare, but distressing condition that can cause significant anxiety for affected patients. We present the case of a 23-year-old man who arrived at our emergency department with sudden penile swelling and ecchymosis following sexual intercourse. The patient reported immediate pain and rapid subcutaneous hematoma formation, but did not hear a cracking sound. Clinical examination revealed significant swelling and discoloration over the dorsal aspect of the penis without palpable tunical defect or signs of urethral injury. Given the concern for penile fracture, surgical exploration was performed. Intraoperatively, we identified an isolated rupture of the superficial dorsal vein with an extensive hematoma, but an intact tunica albuginea. The injured vessel was ligated, and meticulous hemostasis was achieved before wound closure. The postoperative course was uneventful, and the patient was discharged the following day with recommendations for conservative management, including abstinence from sexual activity for four weeks. At the one-month follow-up, the patient reported complete resolution of symptoms with preserved erectile function and no recurrence of hematoma. This case highlights the difficulty in distinguishing superficial dorsal vein rupture from penile fracture based on clinical findings alone and emphasizes the importance of surgical exploration in uncertain cases to ensure proper diagnosis and treatment.