Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2020  |  Volume : 13  |  Issue : 3  |  Page : 233
Blast injury of the scrotum


1 Department of Surgery, All India Institute of Medical Sciences, Nagpur, India
2 Department of Surgery, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India

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Date of Submission21-Apr-2020
Date of Acceptance05-May-2020
Date of Web Publication18-Sep-2020
 

How to cite this article:
Dubhashi SP, Kumar A, Kadam R. Blast injury of the scrotum. J Emerg Trauma Shock 2020;13:233

How to cite this URL:
Dubhashi SP, Kumar A, Kadam R. Blast injury of the scrotum. J Emerg Trauma Shock [serial online] 2020 [cited 2020 Oct 30];13:233. Available from: https://www.onlinejets.org/text.asp?2020/13/3/233/295375




Dear Editor,

Scrotal injury can occur with blunt or penetrating trauma. A 25-year-old gentleman presented to the surgical emergency with an avulsed wound over the left side of the scrotum (<50%) with the left testis exposed, showing a mottled appearance [Figure 1]. On history, the patient explained the mechanism of injury as caused due to the impact of a motorcycle tyre burst. Interval between occurrence of blast injury and presentation of the patient was 8 h. Ultrasound Doppler examination revealed altered echotexture of the left testis with absent intratesticular color flow. On table, a breach in tunica albuginea was noted on the posterior aspect of the testis with blood clots, with oozing of dark-colored fluid. Left orchidectomy was performed.
Figure 1: Avulsion of left hemiscrotum with exposed left testis

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The testes and scrotum are relatively protected from severe damage during trauma, due to mobility of the testes within the scrotum, cremasteric reflex, toughness of tunica albuginea, and elasticity of the scrotal skin.[1] A 50 kg direct force is required to cause testicular rupture.[2]

Signs of testicular rupture on ultrasound include heterogeneous parenchyma echotexture and irregular margins, disruption of the tunica vaginalis, and decreased or loss of blood flow on color Doppler sonography.[3] Presence of vascularity within the testicular parenchyma is indicative of its salvageability. Our case had Grade IV scrotal and Grade V testicular injuries.[4] Most of ruptured testes can be salvaged with surgical repair within 72 h of injury.[5] In our case, although the patient presented within 8 h of injury, the impact of the blast injury was large enough to cause Grade V testicular trauma, leading to orchidectomy.

Blast injury of the scrotum is a rare occurrence. Scrotal trauma warrants urgent clinical evaluation and imaging. Point-of-care ultrasound is the need of the hour for an acute scrotum. All penetrating scrotal injuries should be explored. Early intervention can obviate the need for orchidectomy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Grigorian A, Livingston JK, Schubl SD, Hasjim BJ, Mayers D, Kuncir E, et al. National analysis of testicular and scrotal trauma in the USA. Res Rep Urol 2018;10:51-6.  Back to cited text no. 1
    
2.
Wang Z, Yang JR, Huang YM, Wang L, Liu LF, Wei YB, et al. Diagnosis and management of testicular rupture after blunt scrotal trauma: A literature review. Int Urol Nephrol 2016;48:1967-76.  Back to cited text no. 2
    
3.
Wang A, Stormont I, Siddiqui MM. A review of imaging modalities used in the diagnosis and management of scrotal trauma. Curr Urol Rep 2017;18:98.  Back to cited text no. 3
    
4.
Moore EE, Malangoni MA, Cogbill TH, Peterson NE, Champion HR, Jurkovich GJ, et al. Organ injury scaling VII: Cervical vascular, peripheral vascular, adrenal, penis, testis, and scrotum. J Trauma 1996;41:523-4.  Back to cited text no. 4
    
5.
Morey AF, Metro MJ, Carney KJ, Miller KS, McAninch JW. Consensus on genitourinary trauma: External genitalia. BJU Int 2004;94:507-15.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Siddharth Pramod Dubhashi
A2/103, Shivranjan Towers, Someshwarwadi, Pashan, Pune - 411 008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_59_20

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