Page 575 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

550 CHAPTER 2

VetBooks.ir Differential diagnosis SCROTAL AND TESTICULAR TRAUMA
Simple scrotal oedema must be differentiated from
all other causes of scrotal enlargement including Definition/overview
trauma, intrascrotal haemorrhage, hydrocoele, scro- Direct trauma to the scrotum can lead to lacera-
tal hernia, neoplasia and testicular enlargement. tions, oedema, intrascrotal haemorrhage and testis
Scrotal and ventral oedema are classical findings in rupture. Similar to penile injuries, scrotal injuries
EVA infection and also in EIA. must be treated as immediate emergencies due to the
potential for severe sequelae that may terminate a
Diagnosis stallion’s breeding career.
A thorough physical examination is critical to diag-
nosis. Palpation of the enlarged scrotum reveals Aetiology/pathophysiology
thickened skin and difficulty in differentiating Most cases of scrotal and testicular trauma occur
the underlying testes and epididymides. Scrotal during breeding (Figs. 2.153, 2.154) or are due to
oedema is best diagnosed and differentiated from other severe trauma such as a failed attempt to jump
other potential diseases by ultrasonographic exam- a fence.
ination, where in uncomplicated cases the thick-
ened scrotal wall is characterised by increased Clinical presentation
thickness of an echogenic layer, distinct from the The history may include a recent breeding incident.
testis. Conversely, in cases of intrascrotal haemor- The amount of swelling depends on the severity of
rhage or hydrocoele, an accumulation of anechoic injury. Paraphimosis and/or penile injury may also
fluid between the scrotal skin and the testis is typi- be present. If scrotal lacerations are present, the
cally seen. stallion may present with swelling and haemorrhage
from the area.
Management
Treatment is dependent on the inciting cause. In cases Differential diagnosis
of trauma, systemic antibiotics, anti- inflammatories, All causes of scrotal swelling including scrotal
diuretics and cold hydrotherapy are used to combat oedema, scrotal hernia, orchitis, testicular torsion,
inflammation and swelling. Care must be taken dur- hydrocoele and peritonitis.
ing hydrotherapy, since excessive cold application
can be detrimental to blood flow and tissue and skin
health, and also impact on spermatogenesis. Cold 2.154
therapy should be limited to no more than 15–20
minute sessions every 2 hours. Gentle massage of
the scrotum is also effective in improving blood flow
and reducing oedema of the tissues. Application of
emollient dressings and a supportive sling in severe
cases may help reduce gravity-induced oedema in
the early acute stages of treatment.

Prognosis
The prognosis is good for complete recovery pro-
viding the inciting cause is treated appropriately. In
cases of chronic scrotal oedema, disruption of nor-
mal spermatogenesis caused by altered thermoregu-
lation of the testes may cause permanent effects on Fig. 2.154 Stallion with severe scrotal cellulitis
fertility. following a kick from a mare.