Male genital injuries, demand prompt management to prevent long-term  sexual and psychological damage. Injuries to the scrotum and contents may produce impaired fertility.We report our experience in diagnosing and managing a case of a foreign body in the scrotum following a boat engine blast accident. This case report highlights the need for a good history and thorough general examination to establish the mechanism of injury in order to distinguish between an embedded penetrating projectile injury and an injury with an exit wound. Prompt surgical exploration with hematoma evacuation limits complications.Keywords: Blast Injury, Scrotal Haematoma, Ischaemia, Laceration, Penetrating injur

Adusei, B

Edusa, S

Mante, SD

Yeboah, ED

English

AJOL - African Journals Online

  March 2013    S. D. Mante et al                           Foreign body in scrotum from blast accident  50 FOREIGN BODY IN SCROTUM FOLLOWING A BOAT ENGINE BLAST ACCIDENT   S. D. MANTE1, E. D. YEBOAH2, B. ADUSEI1 and S. EDUSA1  1Urology Unit, 37 Military Hospital, P.O. Box KB 282, Korle-Bu, Accra, Ghana, 2Department of Surgery, University of Ghana Medical School, PO Box 4236 Accra, Ghana,    Corresponding Author: Dr. Sunny Doodu Mante  Email: sunnymante44@yahoo.com Conflict of interest: None declared  SUMMARY Male genital injuries, demand prompt management to prevent long-term sexual and psychological damage. Injuries to the scrotum and contents may produce impaired fertility.We report our experience in diagnos-ing and managing a case of a foreign body in the scro-tum following a boat engine blast accident. This case report highlights the need for a good history and thor-ough general examination to establish the mechanism of injury in order to distinguish between an embedded penetrating projectile injury and an injury with an exit wound. Prompt surgical exploration with hematoma evacuation limits complications.  Keywords: Blast Injury, Scrotal Haematoma, Ischae-mia, Laceration, Penetrating injury  INRODUCTION While the exposed and dependant nature of the scrotum makes it vulnerable to traumatic injury, the relative mobility of the scrotum often serves to protect it from serious injury. The testicles are further protected by the tough surrounding tunica albuginea and by the cremasteric reflex.1 Up to 85% of testicular injuries are a result of blunt trauma2,3 and  most of these injuries are sustained during athletic activity. Blunt trauma may cause local haematoma, ecchymosis of the scrotum, or injuries to the testicle, epididymis or spermatic cord. In testicular rupture the tunica albuginea is disrupted, while in intratesticular haematoma the tunica albuginea remains intact.   Haematoceles, in which blood accumulates in the space between the tunica albuginea and tunica vaginalis, and hydroceles, can be the result of trauma. Traumatically induced testicular torsion is another well recognised entity.4 Penetrating injuries to the scrotum can be the result of knife wounds, gunshot or other missile wounds. Scrotal injuries include lacerations, haematomas and delayed blast type injuries. All of the scrotal contents can be injured from projectile trauma.  In wartime, blast injuries to the scrotum may be more common. Bite injuries from both animals and humans can involve the scrotum and, less frequently, the scrotal contents.5   CASE REPORT A 56-year-old man was working on a faulty engine of a boat at sea when it exploded resulting in multiple inju-ries.  The patient was rushed to the trauma and surgical emergency of the 37 Military Hospital for further care.  Patient complained of a headache but had no neck pain, dizziness or palpitations.  He did not have any signifi-cant past medical history or drug history but did admit to being a habitual smoker and drinker.  On examination the patient had soot and oil all over his body, was in pain but was not pale and was well hy-drated.  The patient had multiple superficial lacerations all over his body. His cardiopulmonary system was stable with a pulse rate of 70 beats/min, blood pressure of 120/80mmHg and a respiratory rate of 24 cy-cles/min.  The patient had mild right sided chest com-pression tenderness.  Abdominal findings were unre-markable and examination of his central nervous sys-tem was essentially normal.  The patient sustained a 3cm x 2cm superficial laceration on his upper eyelid.   A close examination of the patient’s trousers and un-derpants revealed a tear which when superimposed was consistent with the location of the laceration on his scrotum.  The scrotal laceration was on the right side of the scrotum and was about 4cm x 3cm. A clot was seen at the site of the laceration and the right side of the scrotum was tender and enlarged with a darkened col-our.     The history of a blast and a general examination of the tear in his trousers and pants tallying with the site of the laceration on his scrotum was consistent with a penetrating projectile trauma and the further lack of an exit wound raised our level of suspicion of there being a foreign body embedded in his scrotum. A clinical impression of a penetrating right scrotal injury by a foreign body which most likely was embedded in the-  March 2013    Volume 47, Number 1   GHANA MEDICAL JOURNAL  51 base of the right scrotal cavity with scrotal hematoma was made.    The patient’s haemoglobin was 11.0g/dl and all the other indices were normal.  A chest x-ray done re-vealed no fractures on the right side of his chest.  How-ever a pelvic x-ray showed an irregular radio-opaque mass on the right side of the patient’s scrotum (Arrow in Figure 1).                                                                        Figure 1 X-ray showing radio-opaque object in right scrotum (Arrow).  The patient was given an initial dose of tetanus prophy-laxis, analgesia and started on antibiotics.  An informed consent was obtained for surgery, which was done un-der general anaesthesia. The findings at surgery were a right scrotal hematoma with swelling (Figure 2), an area of skin necrosis and a metallic foreign body (Fig 3).  Figure 2 Scrotal hematoma                                             An incision was made over the right scrotal area and the hematoma was evacuated.  A 4cm x 6cm rectangu-lar piece of metal was removed from the deeper scrotal layers (Figure 3). The rectangular piece of metal could be part of the engine block. The lacerated testicular vessels were ligated and an ischemic but viable testis was seen hanging on an intact vas deferens and its ves-sels.  The testis was preserved, a drain was left in situ and the laceration was closed in two layers.   The esti-mated blood loss was 100mls.    Figure 3 Metal piece removed from scrotum  Postoperatively the patient did very well and alternate daily dressing was done.  During the course of his ad-mission the patient was able to urinate normally.  The drain was removed on the third post-operative day.  The scrotal swelling continued to decrease and the wound remained clean. On the seventh post-operative day the patient was discharged to continue his regular dressing at a clinic closer to his home and to come for review after a week. Post operative review indicated a normal sized right testis  DISCUSSION Although male genital injuries are rarely life threaten-ing they demand prompt and appropriate management to prevent long-term sexual and psychological dam-age6.  It has been reported that up to 85% of testicular injuries are a result of blunt trauma2,3 with the remain-ing percentage caused by penetrating, bite injuries and self-mutilation or assault.6 According to the  literature up to 83% of patients presenting with penetrating trauma to the scrotum or penis have other injuries.7,8   Our patient sustained several superficial injuries due to metal pieces and a laceration on his upper eyelid.     In our patient the history of a blast and a general exam-ination of the tear in his trousers and pants tallying with the site of the laceration on his scrotum was con-sistent with a penetrating projectile trauma and the fur-ther lack of an exit wound raised our level of suspicion of there being a foreign body embedded in his scrotum.  An adequate physical examination was difficult to ob-tain, as there was a lot of scrotal pain and swelling.    Even though scrotal ultrasonography (SUS) is the most sensitive and specific imaging method for detecting intrascrotal injury9-12, penetrating trauma to the scro-tum or penis warrants prompt surgical exploration to accurately assess the extent of damage to the reproduc-tive organs and prevent complications.6 Our patient had no testicular rupture and our decision to evacuate the large hematoma is supported by reports in literature, which recommends hematoma evacuation to prevent infectious complications, prolonged pain, disability and ischemia of the testis from compression.13    March 2013    S. D. Mante et al                           Foreign body in scrotum from blast accident  52 Even though the use of a retrograde urethrogram (RUG) has been recommended in the setting of pene-trating genital injuries6 it was not done in this case as intraoperative findings did not suggest any urethral damage.Viable testicular tissue should be salvaged when possible because endocrine function is usually maintained, and the psychological benefit of preserving the native testicle is considered to be substantial. Follow up studies show no detrimental effect of testicular salvage on subsequent fertility.2, 14   However, when massive injury is sustained, resulting in scant viable testicular parenchyma, orchidectomy should follow .McCormack et al 14 reported the value of early exploration and repair in reducing complications and hospitalization. A few years later, Gross 15 reported that the probability of testicular salvage after blunt trauma decreased from 80% to 32% if the exploration was delayed by more than 3 days. Jeffrey et al 16 and Lupetin et al11 similarly reported the rate of testicular salvage to be 90%	   when explored within 72 h, and only 45% when surgery was delayed by > 72 h.  CONCLUSION This case report highlights the need for a good history and thorough general examination to establish the mechanism of injury in order to distinguish between an embedded penetrating projectile injury and an injury with an exit wound.  It has also shown that prompt sur-gical exploration with hematoma evacuation is im-portant if complications are to be kept to a minimum.     REFERENCES 1.  Cass AS. Testicular trauma. J Urol 1983; 129: 299–300. 2.  McAninch JW, Kahn RI, Jeffrey RB, Laing FC, Krieger MJ. Major traumatic and septic genital injuries.J Trauma 1984; 24 : 291–8. 3.  Cass AS, Luxenberg M. Testicular injuries. Urology1991;37 : 528–30. 4.  Seng YJ, Moissinac K. Trauma induced  testicular torsion. a reminder for the unwary. J Accid Emerg Med 2000;17: 381–2. 5.  Gomes CM, Ribeiro-Filho L, Giron AM, Mitre AI, Figueria ER, Arap S. Genital trauma due to animal bites.J Urol 2000; 165 : 80–3. 6.   Morey AF, Metro MJ, Carney KJ, Miller KS, McAninch JW.  Consensus on genitourinary trau-ma: external genitalia.  British Journal of Urology 2004; 94:507-515. 7.   Gomez RG, Castanheira ACC, McAninch JW.  Gunshot wounds to the male genitalia.  J Urol 1993; 150:1147-1149. 8.  Cline KJ, Mata JA, Venable DD, Eastham JA.  Penetrating trauma to the male genitalia. J Trauma 1998; 44:492-494. 9.  Albert NE.  Testicular ultrasound for trauma.  J Urol 1980 October; 124:558-559/ 10.  McConnell JD, Peters PC, Lewis SE.  Testicular rupture in blunt scrotal trauma.  A review of 15 cases with recent application of testicular scan-ning.  J Urol 1982; 128:309-311. 11.  Lupetin AR, King W, Rich PJ, Ledeman RB.  The traumatized scrotum.  Ultrasound evaluation.  Ra-diology 1983; 148:203-207. 12.  Anderson KA, McAninch JW, Jeffrey RB, Laing FC.   Ultrasonography for the diagnosis and stag-ing of blunt scrotal trauma.  J Urol 1983; 130:993-995. 13.  Kukadia AN, Ercole CJ, Gleich P, Hensleigh H, Pryor JL. Testicular trauma. potential impact on reproductive function. J Urol 1996; 156 : 1643–6. 14.  McCormack JL, Kretz AW, Tocantis R. Traumatic rupture of the testicle. J Urol 1966; 96 : 80- 2. 15.  Gross M. Rupture of the testicle: The importance of early surgical treatment. J Urol 1969; 101 : 196–7. 16.   Jeffrey RB, Laing FC, Hricak H, McAninch JW. Sonography of testicular trauma. Am J Roentgenol 1983; 141: 993–5 ✪   

Foreign body in scrotum following a boat engine blast accident

https://www.ajol.info/index.php/gmj/article/download/88781/78364

Foreign body in scrotum following a boat engine blast accident

Abstract

Similar works

Full text

Available Versions

AJOL - African Journals Online