Scroti

"I just don't get it, why would anyone want to keep something like that at home?" Lona echoed all our thoughts. I mean, really, I ask you, how could one let one's scrotum get like that. Maybe a little bulge, but 3 liters!!!

I was called in as usual in the middle of the night for the emergency. It just started hurting yesterday. You never had any problems before? No, it just came on suddenly. No vomiting? No. What then? Pain, it hurts.

There is something strange about a man lying on an exam table wearing nothing but a wrap around skirt looking like he's hiding a small animal between his legs. As he gingerly lifts up his skirt I see a two-football sized scrotum emerge into view.

The first trick is to figure out if it's a hernia with intestines and other abdominal stuff inside or if it's just a hydrocele (a collection, often massive, of liquid around the teste that doesn't usually communicate with the abdomen) caused mostly by small parasites called filaria. I just stared in awe. I mean, we often make jokes about the size of the hydroceles that we see here, but this one takes the cake! Obviously, this didn't happen over the last few days. In fact, on further questioning he says it's been years! I ask you, would you...I don't get it...

We hospitalize him and schedule surgery during which we remove 3 liters of straw colored fluid then hack off a 10 inch hunk of scrotal skin with hydrocele attached, suture the rest around back of the testicule and somehow manage to get the rest sewed back together. Afterwards, it is far from aesthetically pleasing, but at least he can wear his skirt without bulging and walk without waddling bowlegged.

The next guy I wished was a hydrocele. His scrotum was only about a football size. This had been sudden...at least this episode. It all came out and he started vomiting and writhing in pain. He's had a hernia operated on years ago on the same side that had recurred over the last two years. He'd always been able to get it back in before but not now.

The scrotum was bulging at the inguinal area with bowel sounds audible and even the shape of the intestines visible through the skin. We knocked him out with Ketamine and Valium but soon realized it wasn't going back in. We rushed him to the OR and slashed a diagonal down across the mass, dissected into the hernia sac and found small intestine, cecum (large bowel) and appendix inside. All of them were looking a little dusky from being strangulated. Even then it wouldn't go back in. Finally, we had to cut the hernia bigger which pinked up the intestine and allowed it to finally be pushed inside after which the hole was closed.

For our third sac of the week, we have a young man with only a small half a football sized hernia suddenly that evening at 6pm. He came to us at 11pm. I was exhausted already and didn't want to have to operate that night. I gave him many good drugs. I pushed, I manipulated, I massaged, I wrung, I forced, I dripped great, big piles of sweat all over him, I twisted and pried and prodded until my hands, arms and fingers were cramping. I didn't see any progress after an hour. I prayed. I continued in desperations. I didn't feel I had the strength. Slowly, I felt wiggling and heard some gurgling. It started to go in. I persisted 20 more minutes and with the help of the nurse it finally went in. What joy to feel that final sucking in and see the scrotum normal (a rare site here)!

A running joke here is my famous saying, "that's the beauty of the scrotum". Kind of sarcastic in a way, but even something as gnarly and nasty as the scrotum does have its amazing qualities. When one cuts into the scrotum, the skin and muscles contract up to close the wound almost making stitches superfluous. But in the face of the above cases, I ask you, is there really such a thing? And wouldn't you seek help sooner if it was you...seriously...wouldn't you?

James