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Case 129

Barbara Pawel


A 15-year-old male presents to the emergency department with a gunshot wound (GSW) to the left thigh. He is complaining of left thigh and groin pain.

What are the mechanisms of injury that present with penetrating scrotal trauma?


Bicycle handlebars, falls with impalement, animal bites, stab wounds, and GSWs can all result in penetrating trauma to the scrotum and testes.

Penetrating wounds to the lower abdomen, pelvis, penis, rectum, and upper thighs may involve the scrotum due to anatomical proximity. GSWs to the lower extremities are commonly associated with scrotal wounds. A thorough examination to determine entrance and exit wounds in addition to careful inspection of the scrotal skin for lacerations and ecchymosis is necessary. Any penetrating trauma through the dartos layer has a high association of testicular injury. Significant pain with marked edema localized to the testicle or scrotum requires early surgical consultation. Assess the testicular lie and tenderness, the cremasteric reflex, and quality of the femoral artery pulses. The presence of a hematocele (blood within the tunica vaginalis but outside of the tunica albuginea) is concerning for a testicular rupture and ultrasound is recommended. Scrotal edema/ecchymosis may also be caused by blood tracking from an intra- abdominal injury through a patent processus vaginalis.

Keywords: penetrating trauma, GU trauma, urology


American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS) Student Course

Manual. 9th ed. Chicago: American College of Surageons, 2012.

Simhan J, Rothman J, Canter D, Reyes JM, Jaffe WI, Pontari MA, Doumanian LR, Mydlo JH. Gunshot wounds to the scrotum: A large single-institutional 20-year experience. BJU Int 2012;109(11):1704–7.

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