Trans-scrotal intra-abdominal injuries: two case reports.

Penetrating injury to the scrotum is uncommon. Usually not serious in itself it may be associated with other more serious conditions. A 15-year-old boy was involved in a tobogganing accident, and a shard of wood penetrated the left scrotum, the anterior abdominal wall and the rectus sheath one-third of the way from umbilicus to xiphisternum. There was also a liver laceration. Removal of the piece of wood and closure of the wounds with drainage resulted in successful recovery. A 45-year-old man, sustained a penetrating straddle-type injury from a broom handle. The handle penetrated Dartos fascia but there was no testicular injury. It also perforated the rectus sheath 6 cm inferior to the costal margin, and both anterior and posterior gastric walls. The tract of the handle extended along the base of the transverse mesocolon and posterior to the pancreas. The perforations were debrided and repaired. The patient received a 5-day course of broad-spectrum antibiotics and recovered fully. As a result of their experience with these two patients the authors recommend that when there is penetration of Dartos fascia, the testicle and cord should be inspected, lavage and débridement should be carried out, and any foreign bodies should be removed and the injuries repaired. Antibiotics should be given perioperatively. In all cases the entire tract should be explored to its terminus to search for other injuries. Even upper abdominal injuries can occur with penetrating scrotal injuries.