ABSTRACT
A 3-year-old boy was brought to the emergency department (ED) with a scrotal laceration. The mother stated that she was changing the boy in the kitchen after he had soiled his clothes while playing. She left the room to get a new outfit. She heard a thud and the child screaming. She found him on the floor with a bloody wound to ‘his privates’. She described the child as very active and believed that he fell from the kitchen counter while climbing up to retrieve a toy. She stated that he hit a cabinet drawer handle. The ED staff were concerned that the laceration was not consistent with the history. The laceration was length-wise on the scrotum and handles on drawers are usually horizontal and concave. A report was made to Child Protective Services to investigate further (Images 131a and 131b).
Were the ED staff’s concerns reasonable given the images provided?
How can a scene evaluation provide the needed information? What would be helpful?
https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig131a.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig131b.jpg"/>298Scrotal injuries in young children are unusual and warrant further investigation.
On inspection of the kitchen, it was found that the drawer handles were designed as an H configuration with a horizontal element to pull the drawer open with a decorative, spiral-shaped metal ornament on either side of the bar in a vertical direction. Such a decorative pull could account for the scrotal laceration since the child was totally undressed at the time of the injury. 1 , 2
