Pediatric emergency medicine trisk 1183 1183

Scrotal trauma is a spectrum of injuries that ranges from minimal scrotal swelling to rupture of the testis with a tense, blood-filled scrotum ( Fig 61.7A ) Scrotal ultrasound is useful in assessing the integrity of the testicle and the location of fluid within the scrotum ( Fig 61.7B ) Urgent surgical evaluation should occur, unless the testis is clearly normal and without significant tenderness Note that testicular torsion may present with a spurious history of trauma and a ruptured testis has the best salvage rate when surgically repaired An obvious ecchymosis of the scrotal wall after trauma suggests a hematocele, which is blood within the tunica vaginalis Severe testicular injury can be associated with a hematocele, an intratesticular hematoma, or a laceration or rupture of the tunica albuginea which directly encases the testicle Sonography can localize and identify blood, which is more echogenic than hydrocele fluid Color Doppler ultrasound can also assess testicular blood flow Scrotal exploration is indicated if testicular rupture or laceration is present, or in cases of large hematoceles as they heal more readily after surgical drainage If the tunica albuginea can be determined to be intact, no surgical intervention is necessary FIGURE 61.7 Rupture of testis A: Testicular swelling and tenderness following kick to scrotum B: Ultrasound examination of testis—central linear sonolucent area reflects site of testicular rupture Surgical repair resulted in a well-preserved gonad If a scrotal laceration is present, it is essential that the testis and spermatic cord be evaluated for possible injury This may require an examination under general anesthesia or an inguinal cord block with more severe injuries For simple scrotal lacerations, careful hemostasis and closure of the laceration with chromic catgut is sufficient Traumatic epididymitis is local inflammation, resulting from blunt trauma to the scrotum, which usually evolves over a few days Short-lived, acute pain