SCROTAL ABNORMALITIES-TRAUMA

Question 1

Pertinent anatomy of a patient with Scrotal Abnormalities.

Answer 1

(a) Scrotum and its contents including
1) Testicle
2) Epididymis
3) Spermatic cord (vas deferens, cremasteric muscle, artery, vein, nerves)**

Question 2

Signs and symptoms

Answer 2

(a) For all patients with blunt or penetrating trauma, evaluate airway breathing, circulation and disability during the primary survey per advanced trauma life support protocol.
(b) Tenderness to palpation
(c) Ecchymosis
(d) Swelling
(e) Laceration
(f) Bleeding

Question 3

Differential Diagnosis

Answer 3

(a) Scrotal skin avulsion/laceration
1) Should be explored and debrided.**
2) Managed by housing the testicle in the remaining scrotal skin even if the repair may place the skin under tension
(b) Blunt testicular injury
1) Usually occurs secondary to a direct blow to the testis impinging against the pubic symphysis (i.e. bicycle injury).
2) Results in**
a) Contusion
b) Rupture
3) Sac fills with blood and appears as a large blue tender scrotal mas
(c) Penetrating trauma
1) With or without testicular involvement

Question 4

Laboratory Orders/Justification

Answer 4

(a) CBC (looking for anemia or infection)

b) UA (looking for hematuria

Question 5

Imaging

Answer 5

(a) Scrotal and testicular ultrasound

1) Colored Doppler studies can help delineate extent of testicular involvement and evaluate for testicular rupture.

Question 6

Treatment

Answer 6

(a) Blunt and penetrating testicular injuries require MEDEVAC to urology**
1) Exploration, evacuation of blood clots and repair of testicular rupture.
(b) Lacerations or avulsions just involving the skin can be closed primarily by independent provider.**

Question 7

Complications

Answer 7

(a) Hematoma infection
(b) Testicular atrophy
(c) Fournier’s gangrene