<p>Blunt scrotal trauma to a solitary testis is rare and presents significant diagnostic and therapeutic challenges, particularly in elderly males where preserving endogenous testosterone production is critical for metabolic, cardiovascular, and psychological health. We report a 54-year-old man with a history of prior orchiectomy who presented two days after sustaining blunt trauma to his remaining testis. Ultrasonography revealed a tunica albuginea defect with extruded, poorly perfused parenchyma consistent with testicular rupture. Surgical exploration demonstrated a focal tunical tear with gangrenous tissue, which was debrided before reconstruction and closure of the tunica albuginea, resulting in successful testicular salvage. Postoperatively, ultrasonography confirmed preserved vascularity, and serum testosterone levels remained within normal range, demonstrating both hormone-preserving benefit and excellent functional outcome. This case underscores the importance of timely diagnosis, meticulous viability assessment, and organ-preserving repair in solitary-testis trauma. We also propose a practical management algorithm to guide clinicians in such high-stakes situations.</p>