I’m not a huge fan of testicular pain.  In general, the vast majority of the time, I can never really figure out what is causing it. Of course you rule out the bad (but rare) stuff like testicular torsion or cancer but with the exception of a hydrocoele, I can rarely tell exactly what the cause is.

The other day, a guy came in with this complaint. He looked normal enough and did not appear to be ill at all.  The pain started about 5 days ago and he seemed like he considered it more of an irritation.  So it was with immense dismay that when I peered under his gown I saw that his scrotum was about 5 sizes bigger than it should, it was deeply red and had boggy, peeling skin on it!

I immediately went from “OK, order the sonogram, check the urine, blah, blah, blah, to HOLY CRAP, call a surgeon, start some antibiotics!!!’

The guy had Fornier’s Gangrene and went rapidly to the OR where most of the skin off his testicles, perineum, and lower abdominal wall were excised.  Luckily, he is still alive.

Me: “Hello, Ma’am, I see you’ve been scratching yourself pretty badly – your skin is all ripped up.”

Pt: “Yeah, I just KNOW I am infected with mould!  It’s integrated itself so far into my body that it’s releasing spores!!!!”

Me: “Ummmm, I don’t think it’s mould”

Pt: “It HAS to be.  I have already had my house checked for fleas, termites, bedbugs, mice, rats, ants, and silverfish!  I’m trying to find a moss and mould specialist. Do you know any?”

Me: “Yes” (hands patient the office number of a pain-in-the-ass Dermatologist I don’t like).

Chief complaint: My mother’s giant cancer on her neck is infected with maggots.  We could see them having a grand ole’ time in there chowing down on the necrotic tissue. 

Normally, I would say just to leave it alone and let them do their work.  After all, they only eat dead tissue and are nature’s best method of debridement.  However, the whole thing was basically falling apart and bleeding and causing her a lot of pain so she had to go get it cut away.  Only in the ER could someone see this and then go run to the cafeteria….