Stab wound to the groin/scrotum

[jaeida8]

Around 5 am this morning, paramedics brought in a late 40ish-50ish white male inmate was brought to the ED with a "stab wound to the groin/scrotum/testicles (don't remember the exact wording)". When we actually looked at this guy, there were 2 vertical incisions, both testicles were out of the scrotum, and torniquets were tied around the spermatic cords bilaterally. Apparently, he is in jail for sexual assault and he was "mad" at his testicles and said his mom told him to cut them off...so he methodically used a razor blade to make these 2 small incisions and pulled out the testicles and then placed tourniquets around the spermatic cords and was planning to cut them off ...but he passed out before he could finish the job.

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[ISU_Steve]

Wow.....too bad he didn't bleed out. (I have no sympathy for rapists and molestors).

 

[jaeida8]

Yeah we felt the same way. He didn't have a huge amount of blood loss because the incisions he made were small and it was almost like he had done some kind of surgical procedure.

 

[a_ditchdoc]

Man, that has gotta to STING!

The worst I ever saw was a young guy that had a .25 cal bullet traverse his thigh and lodge in his testicle. He didn't complain much about his leg...

 

[fantasty]

Umm.... I caught this documentary the other day. I think it was on HBO or Sundance, and I think it was American Eunuchs: http://www.imdb.com/title/tt0364942/
Anyway - apparently there is a small but active community of guys who have castrated themselves. They use some of the tools used on livestock, including some devices to either rubber band or crush the spermatic cord.

 

[Febrifuge]

Great. Now reading this has made my own testes retreat into my abdomen. (If they don't come out by tomorrow, I think that means we get another six weeks of summer humidity.)

Frickin' ow.

 

[Jeff698]

I suspect this is more common that we would first suspect. I saw a guy during my 4th year EM rotation who'd done the same thing (also a prisoner).

I actually saw him on his second ED visit of the day. His testicle was salvaged on the first visit and he was sent back to the unit. He apparently wasn't one to let failure get in his way. He came back with the testicle again out of the scrotum. This time, however, it was covered in fecal matter.

I still get grossed out when I think of that. Of course, it doesn't help that I associate inmates with the chlamydia that grew from a culture taken from a prisoner's ostomy site.

Take care,
Jeff

 

[Paws]

This is what I love about EM, the really interesting clinical cases as well as the fragrant bouquet of psychology mixed in there, just so ...

 

[docB]

(If they don't come out by tomorrow, I think that means we get another six weeks of summer humidity.)

LOL! I don't even know what you're going to call your new holiday. Feb 2 is taken.

I actually saw 3 of these during residnecy:
-One guy came in saying he had been stabbed by someone in the scrotum. He had a bunch of make up on but he was convincing if weird and the story didn't make sense (how do you get stabbed in the back of the scrotum during a fight?). We figured he had an argument with a lover and was embarrased. When the Uro guys got down they were pissed because they all knew the guy. He had been badgering the Uro clinic for months to castrate him.
-One guy was a prisoner who mutilated his genitals so often that we'd just call Uro when he showed up and say "Mr. So and So's here again." and they'd just come on down without a fight.
-One guy was pretty smart and realized that he didn't have to castrate himself. He figured that if he just jacked his nads up enough the Uro guys would have to complete it for him. Strap a thich rubber band around each nugget and leave it for A WEEK and there you are.

BTW "fragrant bouquet" is such an appropriate term for so many things in the ED I'm going to use it regularly. Props to Paws.

 

[jaeida8]

I think what was really weird about this case as compared to the other ones you guys mentioned is how surgical this guy's approach was. There were two small incisions and nothing was mutilated. He had these two "tourniquets" around the spermatic cords that looked like scrub pant ties....which he apparently didn't tie tight enough because the testicles looked viable. The testicles were completely intact, perfused, not one nick on them.

 

[roja]

The perseverence of some patients is amazing.