Scrotal trauma is rare and can lead to infertility, especially with bilateral injury.

Epididymal injuries are often overlooked but can cause obstructive azoospermia.

Ultrasound may miss epididymal injuries, requiring high clinical suspicion.

Early fertility preservation strategies, such as TESE, should be considered.

Microsurgical epididymal reconstruction may improve fertility in select cases.

Scrotal trauma, though uncommon, can rarely result in isolated epididymal injury, as seen in a rare case of bilateral epididymal injury leading to obstructive infertility in a 23-year-old male who sustained blunt scrotal trauma. Doppler ultrasound revealed bilateral hematocele and epididymal discontinuity, which was confirmed by surgical exploration showing bilateral epididymal lacerations. Postoperative semen analysis indicated azoospermia. Isolated epididymal injuries are rarely diagnosed early, emphasizing the importance of thorough imaging and consideration of fertility preservation. Urologists should consider early sperm preservation in cases with a high risk of infertility.

Scrotal trauma

Epididymal injury

Azoospermia

Fertility preservation

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