PRESENTATION:Injury to the scrotum-4 hours
HISTORY:Patient was in his usual state of health until early on within the day when he fell from a mango tree and landed on his side(part of the head hitting the ground) and sustained an injury to the scrotum in the process.There was a sharp pain in the groin with protrusion of the left testis.Mother then quickly rushed patient to KATH for further management.
ODQ:Headaches-,Loss of consciousness-,Seizures-,Bleeding from ENT orifices-,Hematuria-,Bleeding from affected scrotal site-
PMHX and SH-No known chronic illnesses,no previous admissions or surgeries.
DHX:Not on any long term medications.
FHX:No known chronic illnesses.
SHX:JHS 1 student,Alcohol-,Smoking-,Lives with mother.
O/E-Young male lying in bed with left lower limb flexed,anicteric,not pale,afebrile(36.2C)
CVS:S1+S2+0,HR-99bpm,BP-,warm extremities,pulse volume good.
CNS-Conscious and alert,well oriented.
RS:RR-18cpm,SPO2-98% on RA ,No chest compression tenderness,Chest clinically clear.
Abd:Flat,moves with respiration,umbilicus inverted,soft,non tender,L-,S-,2K-BS+ and normal.
Status localis:Scrotal trauma-5cm laceration of the left hemiscrotum with evisceration of the left testis,Right hemiscrotum and penile shaft intact.No blood seen at urethral meatus. Tenderness of the left hemiscrotum.
under mild sedation with 5mg if iv midazolam and penile cord block with 1% of 10mls xylocaine wound irrigation done with saline. testes and vessels examined and found to be viable . testis returned to the scrotum. vicryl 3/0 suture used to repair the free edges of the tunica in continues suturing. the scrotal skin repaired with interrupted sutures . post op satisfactory . Post operative scrotal doppler was normal in both ipsilateral and contralateral testes . patient was discharged after 24hrs .
Surgeon : Dr Richard Ametih ( urology resident)
Assistant surgeon : Dr Marian Quansah( House Officer)