UCSF MEDICAL STUDENTS

I wonder when he noticed his balls had turned black

He was 40 years old, so I don’t think age was an excuse. He didn’t have a history of mental illness or psychosis, so we couldn’t use that as an excuse either. But he did come in with black balls, and we did take him to the operating room.

“Maybe,” said a nurse, “his glucose was so high, he wasn’t in his right set of mind. Maybe that is why he came in so late, when the disease had significantly advanced.” Maybe, I thought.

At the emergency room, he was somnolent and altered. The physicians there then intubated him. He was then brought to our hospital.

When we met him, he was already intubated. A decision was made, incorrectly likely, to put in a central line.  I say incorrectly because this was an obvious case of necrotizing fasciitis, specifically Fournier gangrene, or in laymen’s terms,  “infected, black balls.” This was not the time to mess around with a central line in the emergency department. But it was then, and they also gave him  gift of a pnemothorax, requiring us to place a central line.

The balls were really back. The scrotal sac, I mean, was dark green/black. Ok, so I’ve made my point, I think.

The smell was outrageous. We each asked for Oil of Wintergreen to be plastered on our masks.

The guy’s scrotal sacs had to go. His abdominal wall had to go. The extent of this necrotizing fasciitis was incredible. His penile tissue had to go.

Anyone who can bear child, probably wants their organs to be preserved. Lucky for him, his testicles were not infected. We disseced out the spermatic cord and the testicles. The rest of the skin in that area had to go.

Oh did I forget to mention that he also was a diabetic? His blood sugars were in the 900′s during the operation. His lactate was 4.6. His potassium was 1.3. Those labs were corrected during the operation, thanks to the magic of the anesthesiologists.

But, clearly his diabetes played a role. Patient’s with diabetes are at risk for necrotizing frasciitis.

After the operation, we still wondered, what took him so long to get to the hospital? After all, he had noticed a small amount of abscess in his groin. And 2 3 days later, he is in the hospital intubated, sick, with most of his abdominal wall (down to the aponeuroses), is gone, with a naken (fascia-less) penis and testes.

So the question is, when did he notice his balls were black ? And why didn’t he come to the hopital sooner?

Lesson here? If there is something wrong with your private parts, expecially something that looks like an infection, go see the doctor immediately.

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