Pediatric emergency medicine trisk 3331 3331
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exploration is performed within 24 hours of the injury. Ultrasonography has
shown poor accuracy, however, for the evaluation of isolated epididymal lesions.
Other injuries requiring surgical management include tense hematoceles and
torsion after trauma.
Testicular dislocation may occur either as a result of an upward blow to the
scrotum or, rarely, as a result of compressive displacement following severe blunt
abdominal trauma. Dislocation has been described in the context of mild scrotal
trauma as well. Diagnosis of testicular dislocation can be made by thorough
physical examination, including palpation of the testes. Examination will reveal a
well-developed, but empty, scrotal sac or palpation of an abnormally located
testis. Severe scrotal pain, obesity, ecchymosis, swelling, or associated pelvic
injuries may make examination and diagnosis difficult. In most cases, the
dislocated testis lies in the inguinal canal. Associated injuries, such as pelvic
fracture, are common. Operative repair is required if closed reduction fails.
PENIS
Clinical Recognition
The most common cause of penile trauma in infants is iatrogenic, especially at the
time of circumcision. Complications include transection of the glans,
urethrocutaneous fistula, deskinning of the penile shaft, and coagulation necrosis
of the entire penis from electrocautery. These injuries usually require extensive
surgical repair.
Penile gunshot wounds are uncommon because of the position and mobility of
the penis but have the potential to significantly affect quality of life. Signs that
may indicate corpora cavernosa injury include uncontrolled bleeding, expanding
hematoma, blood at the meatus, or a palpable corporeal defect. Urethral injury
should be ruled out by retrograde urethrography if these signs are present. These
injuries require urologic evaluation to determine the need and timing of surgical
management.
Blunt penile trauma from toilet seats falling on the glans or distal shaft can
occur in toddlers. Significant injury to the corporal bodies or the urethra is
fortunately rare and patients can generally be managed expectantly with warm
soaks. Although the child does not commonly experience urinary retention, he
may be more comfortable voiding in a tub of warm water.
Tourniquet injuries to the penis may result from bands, rings, or human hair. In
the infant, strangulation with a fine hair may be difficult to recognize because of
local edema. The initial diagnosis may be balanitis or paraphimosis. Local or
