A human bite to the scrotum: a case report and review of the literature

Management of Mammalian Bites to the External Genitalia: A Scoping Review

OBJECTIVE

To review the existing publications in literature in order to determine the approaches for the medical and operative management of mammalian bites to the external genitalia.

METHODS AND MATERIAL

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Review guidelines were followed. Four databases were searched. Articles were independently screened and analyzed by two reviewers. Publications were included if detailed summaries of genitalia bites and management were documented. Discrepancies were resolved by a third reviewer. Data was extracted from the final article cohort.

RESULTS

Forty-two articles were included in this scoping review. A total of 67 cases of mammalian bites to the genitalia were reported in the cohort. The most common injury site was the penis (44.9%). Dog and human bites were the most common type of mammalian bites (61.2% and 26.9%, respectively). 13.4% of cases were managed with medical therapy while 86.6% of cases required surgical intervention. The most common intervention was wound irrigation, debridement, and primary closure (32.8%). Though uncommon, other operative approaches included skin flaps (7.5%) and grafts (4.5%), re-implantation (4.5%), urethroplasty/repair (7.5%), penectomy (3.0%), scrotoplasty (3.0%), and perineal urethrostomy (1.5%). The reported complication rate was 19.4%. The mean follow-up time was 39.9 months.

CONCLUSION

Trauma related to mammalian bites is associated with high utilization of healthcare resources and cost. Though management of such bites to the genitalia is controversial, surgical intervention is often warranted ranging from simple debridement of devitalized tissue to complex reconstructive surgery. This review underscores the need for further investigation of mammalian bites to the genitalia to improve surgical options and monitor for long-term complication rates.

A Human Bite on the Scrotum: Case Report and Review of Management in the Emergency Department

BACKGROUND

Human bites involving the genitalia rarely present to the emergency department (ED). They have the potential to cause life-threatening secondary infections as well as serious physical and functional damage.

CASE REPORT

We report a case of an adult male who sustained a human bite to the scrotum, resulting in a ragged laceration on the anterior scrotum, with a devascularized flap and necrotic edges overlying the wound. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Human bites to the scrotum are rare and, hence, the experience of emergency physicians treating patients presenting with these injuries may be minimal. This puts patients at risk of underevaluation or suboptimal treatment. The rapid initiation of antibiotics in the ED and thorough wound debridement will prevent infections, aid healing, and lead to improved outcomes by preserving organ function and integrity. We therefore present a systematic approach to the management of patients with human bite to the scrotum in the ED.

Arrachement du scrotum par morsure humaine: présentation d’un cas et revue de la littérature

La morsure humaine des organes génitaux externes est rare. Nous rapportons un cas de plaie scrotale par morsure humaine, liée à un différend d’ordre sexuel. La lésion était une plaie récente par arrachement du sommet du scrotum, sans atteinte testiculaire. Cette plaie a été favorablement traitée par un parage et une suture scrotale sous couverture d’une antibiothérapie, avec un calendrier vaccinal contre le tétanos à jour.