Pediatric Scrotal Dog Bite

AUTHORS:
Bryce Baird, MD¹ • Erica Mercer, MD²

AFFILIATIONS:
¹Resident Physician, Urology Department, Mayo Clinic Jacksonville, Jacksonville, Florida
²Urology Department, Nemours Children’s Health System, Jacksonville, Florida

CITATION:
Barid B, Mercer E. Pediatric scrotal dog bite. Consultant. 2022;62(6);e31-e32. doi:10.25270/con.2021.11.00005

Received June 25, 2021. Accepted July 13, 2021. Published online November 15, 2021.

DISCLOSURES:
The authors report no relevant financial relationships.

CORRESPONDENCE:
Bryce Baird, MD, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224 (baird.bryce@mayo.edu)

A previously healthy 6-year-old boy presented with his parents to our emergency department with a dog bite to the genitals. The boy and his family were playing with their dog when the dog turned and nipped the boy’s scrotum. This led to a laceration with bleeding and provoked the family to present to the emergency department. The boy had some mild pain associated with the bite, but there were no other health concerns. The patient was up to date on all vaccinations and was immunocompetent.

Physical examination. The patient appeared healthy and had vital signs within normal limits. He was alert and reported mild pain associated with his right hemi-scrotum. Other pertinent physical examination findings included an approximate 5-mm laceration to the cephalad right hemi-scrotum (Figure 1). Both testicles were palpable with no abnormalities, phallus was normal with no evidence of trauma, and cremaster reflex was intact bilaterally.

Figure 1. Gross image of the scrotal wound

Diagnostic testing. Based on the patient’s history and physical examination findings, it was clear that the patient had incurred a dog bite to the scrotum. Additionally, a scrotal ultrasonography scan was performed to ensure the testicles, specifically the right testicle, was intact and that there were no concerns regarding blood flow. The right testicle had normal blood flow and was intact with no evidence of rupture (Figure 2). Additional views confirmed a healthy right testicle and peritesticular tissues and structures, including the epididymis (Figure 3).

Figure 2. Sagittal view of the right testicle with blood flow

Figure 3. Transverse view of the right testicle with epididymis

Discussion. Scrotal wounds from dog bites have been reported in the literature, but it is important to note that a variety of presentations can occur. In addition, there is an overall paucity of literature in regard to scrotal bites in the pediatric population.

One notable case involved a dog bite to the scrotum of a 2-year-old boy with a hernia, which led to a small bowel perforation.¹ Unfortunately, in this perforation case, the presentation was delayed, and an additional leak occurred approximately 2 weeks after the patient’s first exploratory laparotomy. Our case is far more benign than this case, but both are noteworthy as they display the spectrum of events that can occur from dog bites to the scrotum. We also use this perforation example as good reason to arrange outpatient follow-up of individuals presenting with dog bites.

Cord structures and scrotal contents are clearly at risk for damage after a dog bite to the scrotum, as is represented in another pediatric case of traumatic disruption of the right vas deferens, which was repaired by microsurgical vasoepididymal anastomosis.² This is again a different presentation of dog bite and reinforces the use of scrotal ultrasonography. We utilized scrotal ultrasonography in our patient to ensure no scrotal contents were injured. Diagnostic scanning also ensures the testicles are not ruptured or threatened, as has been seen in testicular loss after dog bites.^3,4

As in our case, healthy animals who are up to date on vaccines and available for quarantine can be watched, and the patient can forego any rabies prophylaxis.⁵ In addition, patients who are up to date with their vaccinations and are within 5 years of vaccine administration in the case of a dirty wound or within 10 years of vaccine in a clean, minor wound can avoid tetanus vaccination and immunoglobulin treatment.⁶

Patient outcome. The puncture wound was irrigated with copious saline and povidone-iodine solution, inspected to ensure no deep scrotal structures were apparently seen, and generic triple antibiotic ointment was administered to the wound. Follow-up to our clinic within one week was arranged to ensure that the wound continued healing.

Because of the smaller size of the wound, the decision was made to allow it to heal on its own without reapproximation of tissues. In addition, the patient was prescribed a 7-day course of amoxicillin-clavulanate oral liquid to be taken twice daily. The patient and family were instructed to call if fevers, swelling, purulent discharge, or pain out of proportion were to occur.

Approximately 1 week later, the boy was found to have a well-healing laceration with no signs of infection, swelling, or abnormality.