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INTRATESTICULAR SELF-INJECTION OF TESTGASOLINE
0022-5347/00/1642-045l/O
THEJOURNAL OF UROLOGY@
Vol. 164,451, August 2000 Printed in U.S.A.
Copyright 0 2000 by AMERICAN UROLOCICAL ASSOCIATION, INC.@
INTRATESTICULAR SELF-INJECTION OF TESTGASOLINE JORN H. HAGEMA", STEFAN A. MACHTENS, CHRISTIAN G. STIEF, KLAUS HOFNER UDO JONAS
AND
From the Department of Urology, Hannover Medical School, Hannover, Germany
KEY WORDS:solvents, testis, injection
Testgasoline is a widely used, colorless liquid solvent for enamel colors and so forth. It consists mainly of ligroin, petroleum naphtha, n-hexane and n-pentane. Although autoinoculation of this substance in connection with occupational accidents is common,' to our knowledge we report the first case of intratesticular self-injection of testgasoline. CASE REPORT
An 18-year-old man presented with progressive left testicular and inguinal pain 1hour after self-injection of testgasoline into the left testicle. An anamnestic evaluation revealed that the intention was to obtain sexual satisfaction by manipulation of the testicles. Psychiatric consultation indicated no signs of psychotically motivated self-mutilation. Physical examination, and testicular and abdominal ultrasonography did not show any abnormalities. Scrota1 examination revealed only minor bleeding a t the injection site. Due to the toxicity of testgasoline the left testicle was resected via a scrota1 approach. Postoperatively, ceftriaxone and tobramycin were administered for 12 days to prevent toxic induced pneumonia. Baseline laboratory values revealed that leukocytes were elevated to a maximum of 19,500/mm.3 and C-reactive protein was 173 mg./l. Other serum chemistry studies, including uric acid and creatinine, were normal. The patient had a subnormal body temperature and left flank pain with diffuse pain in the lower abdomen. No significant lesions were revealed on abdominal ultrasound. Directly caudal to the left renal vein magnetic resonance imaging demonstrated a 4 X 2 cm. wide hyperdense formation with wall enhancement, which was ventral to the psoas muscle and down to the level of the 4th lumbar vertebral body equivalent to an aseptic fatty tissue necrosis (fig. 1). Macroscopic pathological examination of the left testicle demonstrated unaltered tissue except for hemorrhagic areas along the injection site. Histopathologically, resorptive inflammation with few necroses surrounding the injection site were revealed (fig. 2). The patient was discharged from the hospital on postoperative day 8 against our medical advice. DISCUSSION
Self-mutilation of the external male genitals is frequently associated with psychotic diseases. However, in some cases there is no evidence of psychopathological motivation associated with genital manipulations.2 Intramuscular inoculation of testgasoline leads to thrombophlebitis and results in local tissue necrosis. At 1hour after injection in our patient physical examination and ultrasound appeared normal except for
FIG.1. Initial T2-weighted transverse magnetic resonance image through abdomen. Bright intense signal medioventral to left kidney represents fatty tissue necrosis.
FIG.2. Reso tive inflammation with few necroses surrounds injection side. H X E, reduced from X40.
pain but the injected agent seemed to have already drained via testicular veins and/or regional lymphatic vessels into the retroperitoneal region. Despite the unobtrusive findings on early examinations drainage of this agent via the ipsilateral spermatic cord and testicular vein must be considered. Therefore, we recommend immediate high inguinal orchiectomy to avoid further complications caused by venous and/or lymphatic drainage of a substance of this type.
Accepted for publication March 17, 2000.
451
REFERENCES
1. Jebson, P. J., Sanderson, M., Rao, V. K. e t al: High-pressure injection injuries of the hand. Wis Med J, 92: 13, 1993 2. Martin, T. and Gattaz, W. F.: Psychatric aspects of male genital self-mutilation. Psychopathology, 24: 170, 1991
THEJOURNAL OF UROLOGY@
Vol. 164,451, August 2000 Printed in U.S.A.
Copyright 0 2000 by AMERICAN UROLOCICAL ASSOCIATION, INC.@
INTRATESTICULAR SELF-INJECTION OF TESTGASOLINE JORN H. HAGEMA", STEFAN A. MACHTENS, CHRISTIAN G. STIEF, KLAUS HOFNER UDO JONAS
AND
From the Department of Urology, Hannover Medical School, Hannover, Germany
KEY WORDS:solvents, testis, injection
Testgasoline is a widely used, colorless liquid solvent for enamel colors and so forth. It consists mainly of ligroin, petroleum naphtha, n-hexane and n-pentane. Although autoinoculation of this substance in connection with occupational accidents is common,' to our knowledge we report the first case of intratesticular self-injection of testgasoline. CASE REPORT
An 18-year-old man presented with progressive left testicular and inguinal pain 1hour after self-injection of testgasoline into the left testicle. An anamnestic evaluation revealed that the intention was to obtain sexual satisfaction by manipulation of the testicles. Psychiatric consultation indicated no signs of psychotically motivated self-mutilation. Physical examination, and testicular and abdominal ultrasonography did not show any abnormalities. Scrota1 examination revealed only minor bleeding a t the injection site. Due to the toxicity of testgasoline the left testicle was resected via a scrota1 approach. Postoperatively, ceftriaxone and tobramycin were administered for 12 days to prevent toxic induced pneumonia. Baseline laboratory values revealed that leukocytes were elevated to a maximum of 19,500/mm.3 and C-reactive protein was 173 mg./l. Other serum chemistry studies, including uric acid and creatinine, were normal. The patient had a subnormal body temperature and left flank pain with diffuse pain in the lower abdomen. No significant lesions were revealed on abdominal ultrasound. Directly caudal to the left renal vein magnetic resonance imaging demonstrated a 4 X 2 cm. wide hyperdense formation with wall enhancement, which was ventral to the psoas muscle and down to the level of the 4th lumbar vertebral body equivalent to an aseptic fatty tissue necrosis (fig. 1). Macroscopic pathological examination of the left testicle demonstrated unaltered tissue except for hemorrhagic areas along the injection site. Histopathologically, resorptive inflammation with few necroses surrounding the injection site were revealed (fig. 2). The patient was discharged from the hospital on postoperative day 8 against our medical advice. DISCUSSION
Self-mutilation of the external male genitals is frequently associated with psychotic diseases. However, in some cases there is no evidence of psychopathological motivation associated with genital manipulations.2 Intramuscular inoculation of testgasoline leads to thrombophlebitis and results in local tissue necrosis. At 1hour after injection in our patient physical examination and ultrasound appeared normal except for
FIG.1. Initial T2-weighted transverse magnetic resonance image through abdomen. Bright intense signal medioventral to left kidney represents fatty tissue necrosis.
FIG.2. Reso tive inflammation with few necroses surrounds injection side. H X E, reduced from X40.
pain but the injected agent seemed to have already drained via testicular veins and/or regional lymphatic vessels into the retroperitoneal region. Despite the unobtrusive findings on early examinations drainage of this agent via the ipsilateral spermatic cord and testicular vein must be considered. Therefore, we recommend immediate high inguinal orchiectomy to avoid further complications caused by venous and/or lymphatic drainage of a substance of this type.
Accepted for publication March 17, 2000.
451
REFERENCES
1. Jebson, P. J., Sanderson, M., Rao, V. K. e t al: High-pressure injection injuries of the hand. Wis Med J, 92: 13, 1993 2. Martin, T. and Gattaz, W. F.: Psychatric aspects of male genital self-mutilation. Psychopathology, 24: 170, 1991