Análisis de casos de escroto agudo en el Hospital Regional de Occidente, Quetzaltenango, Guatemala

Objetivo: establecer la incidencia de orquiectomía debido a escroto agudo en pacientes ingresados al Hospital Regional de Occidente, Quetzaltenango, Guatemala. Introducción: el escroto agudo representa un reto diagnóstico. Los resultados actuales distan mucho de ser óptimos. Material y métodos: se revisaron los expedientes clínicos de los pacientes ingresados por escroto agudo al Hospital Regional de Occidente, de enero del 2014 a diciembre del 2018. Se recolectaron las características epidemiológicas, clínicas y de gabinete necesarias para el estudio. Resultados: orquiectomía se realizó en 41 casos. El grupo etario más afectado fue de 11 a 20 años. Las tres principales causas de escroto agudo fueron; torsión testicular, trauma, y tumores testiculares. El hallazgo clínico más frecuente fue dolor testicular. El hallazgo por ultrasonido más común fue disminución o pérdida de la vascularidad. Discusión: se determinó la incidencia de orquiectomías debidas a escroto agudo; así como las características clínicas, epidemiológicas y de ultrasonido de la entidad. El conocimiento de estos datos permitirá un mejor diagnóstico, manejo y seguimiento de pacientes en nuestra institución.

Post Traumatic Hematocele - Ultrasonography and Elastography Imaging

Hematocele with blunt scrotal trauma is an uncommon cause of the testicular pain. Elastography is the new recent advance in the field of ultrasound. USG and elastography findings of the acute hematocele is described in this aricle. Testicular trauma is the third most common cause of acute scrotal pain,1 and high-frequency ultrasonography (USG) with a linear array transducer is the first preferred modality for testicular trauma evaluation. Extra testicular haematoceles or blood collections inside the tunica vaginalis are the most common findings in the scrotum after blunt injury.2 On clinical assessment, haematocele appears as a hard mass like swelling and causes pain in the scrotum. In the majority of cases, spontaneous resolution occurs with the support of conservative therapy,3 even if treated conservatively, may result in infection, discomfort, or atrophy in undiagnosed broad hematoceles and testicular hematomas over time.4 A testis with its coverings, epididymis, and spermatic cord are all contained in each hemiscrotum. A typical testis is 5 x 3 x 2 cm in diameter and has an intermediate echogenicity. The tunica albuginea is a fibrous covering that protects the testis from damage from the external injuries. It is located on top of the tunica vasculosa, which is made up of capsular arteries. A testis with its coverings, epididymis, and spermatic cord are all contained in each hemiscrotum. With its high tensile strength, the tunica albuginea plays an important role in shielding the testis from trauma. It can withstand a force of up to 50 kg without bursting. The testicular parenchyma is made up of several lobules, each of which is made up of several seminiferous tubules that lead to dilated spaces inside the mediastinum called the rete testis through the tubuli recti. The epididymis is made up of a head, neck, and tail that protects the superolateral part of the testis. The epididymis' tail ends in the spermatic cord as the vas deferens. The epididymal head is a 5 – 12 mm pyramidal structure that sits atop the testis' superior pole. The head is almost isoechoic to the testis. The epididymis has a 2 – 4 mm thick body.5 The patient lies in a supine position with the scrotum covered by a towel positioned between the thighs during scrotal ultrasound. A high-frequency lineararray transducer with a frequency range of 7 – 14 MHz is preferred. The scrotum is always soft to the touch after trauma, making scanning difficult. It should be attempted to examine both the testes and the epididymis in their entirety, as well as any extra testicular lesions. The testes are assessed in two planes: longitudinal and transverse. Each testis and epididymis should be compared to the contralateral testis and epididymis in terms of size and echogenicity. Transverse scrotal imaging is important for depicting both testes and comparing their gray-scale and colour Doppler appearances.

Pediatric Trauma-Induced Testicular Torsion: A Surgical Emergency

<b><i>Objective:</i></b> To evaluate the features of testicular torsion (TT) resulting from minor groin trauma and to raise the awareness of trauma-induced testicular torsion (TITT). <b><i>Methods:</i></b> This is a retrospective chart review of patients presenting with TT resulting from minor genital trauma that was performed from January 2010 to December 2018 at a single tertiary care institution. The demographic, clinical, and perioperative characteristics, as well as data on follow-up and complications, were analyzed. <b><i>Results:</i></b> Of the 155 patients treated for TT, 15 were included in this study. The average age of the patients was 10.3 years (range: 3.2–13.3 years). All patients experienced a direct scrotal trauma and subsequently presented with an ipsilateral scrotal or testicular pain secondary to the twisted testicle. Six patients were misdiagnosed as having scrotal inflammation or hematoma, and all were initially treated at local hospitals. The mean duration of symptoms before hospitalization was 138 h (range: 5–504 h). The mean degree of torsion was 390° (range: 180–720°). The testicular salvation rate, at 33%, was poor. No serious postoperative complications or recurrences of TT was observed. <b><i>Conclusions:</i></b> TITT is a rare entity and still has delayed diagnosis. This may subsequently lead to a low testicular salvation rate. Emergency surgeons, especially in local hospitals, should be aware of the possibility of TT following testicular trauma in pediatric patients. Improving the parents’ awareness regarding TT is also important.

Major trauma

This chapter in the Oxford Handbook of Emergency Medicine investigates major trauma in the emergency department (ED). It reviews general treatment principles, resuscitation, and investigations, and explores airway obstruction, tension pneumothorax, rib fractures, sternal fracture, flail segment, ruptured diaphragm, oesophageal rupture, traumatic pneumothorax, haemothorax, chest drain insertion, pulmonary contusions and aspiration, penetrating chest injury, open chest injury, traumatic cardiac arrest, thoracotomy for cardiac arrest, aortic injury, focused assessment with sonography for trauma (FAST) scan, blunt abdominal trauma, penetrating abdominal trauma, renal trauma, bladder injury, urethral trauma, scrotal and testicular trauma, minor and serious head injury, post-concussion symptoms, carotid/vertebral artery dissection, maxillofacial injuries, mandibular injuries, temporomandibular joint dislocation, penetrating neck trauma, silver trauma, spine and spinal cord injury, dermatomes, gunshot injuries, blast injuries, burns, inhalation injury, and crush syndrome.

Denial and oncological pathology: Case report of a massive testicular cancer

Literature: The cancer of testicles represents 1% of male neoplasms and 5% of urological malignant neoplasm. Its incidence has been growing in Western societies. Cancer of testicles usually presents as an increase of consistence in one testicles and absence of pain, as a casual ultrasound scan finding, or it could be highlighted by a scrotal injury. The surgical treatment is either radical orchiectomy or radical orchiectomy plus retroperitoneal lymph node dissection. Case presentation: The case presented concerns a 48-year-old male with a history of left testicular trauma and subsequent hypotrophy. Over the next 4 years, the patient developed a testicle size increase up to 15 cm in diameter. At diagnosis, he had retroperitoneal lymphadenopathy. The patient was, after surgery, referred to the oncology department. Conclusion: The awareness of the male population respect to testicular cancer and its screening methods (e.g. self-examination) is essential to make the diagnosis at an early stage. It is also essential to psychologically support patients undergoing surgical and/or pharmacological therapy due to risk of determining anxiety or depression compared to the whole population.

Effect of One-Way Blunt Testis on Sperm Parameters in Acute and Chronic Periods after Injury in Mice

Introduction: So far, the effects of blunt trauma on sperm parameters and reproductive capacity have not been firmly established and different reports have been presented. The aim of this study was to investigate the effect of unilateral blunt testis on sperm parameters in acute and chronic periods after injury in mice. Methods: In this study, 40 adult male NMRI mice with a weight of 35-30 gr were selected randomly and divided into 3 groups control, sham and experimental (blunt). Then sperm samples were examined microscopically in terms of motility, number, viability (eosin stain color and Hypoosmotic Swelling) in two acute and chronic. Results: In experimental groups, there was a significant decrease in sperm motility and viability compared to the control group (P<0.05). There was also a significant reduction in the number of sperm in the chronic group compared to the control (P<0.05). Conclusion: Results showed that mice testicular trauma has adverse effects on sperm viability, number and progressive motility. Therefore, it can be concluded that testicular blunt trauma may impair the fertility of males.

Testicular Rupture Following Blunt Scrotal Trauma

Testicular rupture after blunt scrotal trauma is characterized by rupture of the tunica albuginea and extrusion of seminiferous tubules. This is a serious injury and appropriate evaluation and management are necessary both for symptom control, but also for preservation of the testicle. Clinical examination of the scrotum following trauma is difficult and may result in incorrect triage of patients for surgical exploration. This case study describes the assessment and management of blunt testicular trauma in an adolescent lacrosse player.

Intra-Testicular Papaverine Injection for Testicular Salvage after Blunt Testicular Trauma: A Case Report

Blunt trauma is the most common mechanism of injury to the scrotum and testicle. Surgical exploration with primary repair, hematoma evacuation, and de-torsion are common surgical interventions. A 20-year-old male with no previous medical history presented after a high-speed motor vehicle collision. Ultrasonography demonstrated heterogeneous changes of the tunica albuginea and decreased arterial flow to bilateral testicles. He was subsequently taken to the operating room for surgical exploration, which revealed bilateral mottled testes with questionable viability. Papaverine was injected into each testicle, which resulted in visibly increased perfusion and subsequent preservation of the testicles. Conclusion: Current evidence on the use of papaverine is isolated to testicular torsion. Additional research should be conducted on the use of papaverine in blunt testicular trauma. Papaverine injection may be a valuable treatment option when inadequate perfusion is observed intra-operatively.