Penetrating Scrotal Injury: Two Unusual Case Reports in Children and Brief Review of Literature

Introduction:Scrotal trauma is a rare surgical emergency that accounts for less than 1% of all traumatic injuries. They are more prevalent in 15-40 years age group. Blunt scrotal trauma contributes to about 80% of all scrotal injuries whilst penetrating scrotal injuries constitute the remaining 20%. Penetrating scrotal injuries are however, more rare in children but can result from bicycle handlebars, falls with impalement, and animal bites. Case Reports: We did a retrospective review of our records over a 7-year period for penetrating scrotal injuries and report two (2) cases involving 13-year old and 14-year old males who sustained injuries from a tree branch and an iron rod respectively after falling from heights. Discussion:Penetrating scrotal trauma can present with complex injury patterns involving the testes and other surrounding structures, and all invariably need urgent scrotal exploration Consequently, both of our cases had immediate surgical exploration with conservative debridement of non-viable tissue and surprisingly both were spared any testicular injury. Conclusion:Penetrating scrotal trauma may spare the testis and the scrotal contents despite the gravity of the injury.

The Role of Ultrasonography in Identifying Testicular Rupture after Blunt Scrotal Trauma / 대한비뇨기과학회지

To determine the value of ultrasonography for the diagnosis of testicular rapture due to blunt trauma, we reviewed 69 patients of blunt scrotal trauma, which were evaluated by ultrasound before treatment. Thirty patients were managed conservatively, of which 3 cases were explored lately due to persistent pain or mass, and 39 explored immediately. Of the 30 patients treated conservatively the injury was resolved in 27. Surgical exploration of the 42 cases revealed testicular rupture in 29 and simple hematocele in 13. Analysis of the 29 cases with testicular rupture demonstrated that orchiectomy rates were 20% in early exploration and 53% in delayed exploration. in the 27 cases the testicular rupture was correctly diagnosed by ultrasonography, and there were 4 false-positive and 2 false-negative diagnoses of rupture. The specificity and sensitivity for the diagnosis of testicular rupture are 70% and 93%, and the positive and negative predictive values are 87% and 82%, respectively. Ultrasonography used in conjunction with a thorough physical examination is highly sensitive in identifying testicular rupture, and can provide objective information supporting the need for early surgical exploration in patients with blunt scrotal trauma.

Scrotal Blunt Trauma: 3 Cases / 대한비뇨기과학회지

Because of its motility and position, the scrotum is infrequently injured after blunt trauma. We have recently experienced traumatic testicular torsion, testicular rupture, and epididymal rupture with abscess formation after blunt scrotal trauma. We have explored early and treated properly.

Clinical Observation on Scrotal Trauma / 대한비뇨기과학회지

We have reported 50 cases of scrotal trauma during the period from Feb. l, l982 to Apr. 1. 1985. All of them were evaluated by careful physical examination and ultrasound. And then all suspicious cases of testicular rupture and severe scrotal swelling were explored surgically as soon as possible. The results were as follows: 1. Kick or blow was the most frequent cause of the injury (78%) and the next was gunshot injury (12%). 2. The incidence of testicular rupture in patients with scrotal trauma was 38%. 3. The rate of orchiectomy in the cases of early exploration was 16.7% and 61.5% in delay exploration. 4. Ultrasound examination was helpful in identifying rapidly those patients who needed surgical repair. Homogenous echoes were produced by normal testicular contents, whereas areas of disruption and hemorrhage appeared dense clusters of echoes. Accurate diagnostic rates of testicular rupture and scrotal hematoma by scrotal sonography were 9l.7% (11/l2) and 95% (19/20). 5. The complications including epididymitis, hydrocele scrotal abscess and testicular atrophy occurred 38.9% in conservative treatment, l6.7% in early exploration and 25% in delay exploration. 6. Early exploration for scrotal trauma decreased not only the change of the testicular loss but also complications.

A Clinical Observation on Scrotal Trauma and Testicular Rupture / 대한비뇨기과학회지

The incidence of testicular rupture by blunt trauma has been considered rare. But if testicular rupture has developed, the diagnosis of which is difficult. In the 50 cases of scrotal trauma patients, we investigated in the frequency of testicular rupture and early exploration in comparison with delayed exploration. Then the incidence of testicular rupture was in 46.1% of the cases of exploration, and early exploration of for scrotal trauma has resulted in higher testicular salvage rate than delayed exploration.

A Clinical Observation on Scrotal Trauma and Testicular Rupture / 대한비뇨기과학회지

The incidence of testicular rupture by blunt trauma has been considered rare. But if testicular rupture has developed, the diagnosis of which is difficult. In the 50 cases of scrotal trauma patients, we investigated in the frequency of testicular rupture and early exploration in comparison with delayed exploration. Then the incidence of testicular rupture was in 46.1% of the cases of exploration, and early exploration of for scrotal trauma has resulted in higher testicular salvage rate than delayed exploration.