A factory worker had to have a nail removed from his scrotum after he accidentally shot himself with a nail gun.
The unidentified 27-year-old man, from Italy, was rushed to hospital after his horrific pneumatic gun injury.
But when doctors first looked at his scrotum, they could not see any sign of the nail — despite him being in obvious agony.
There was no clear wound in his skin, forcing medics to use an ultrasound to find the hidden 1.8cm nail.
Urologists noticed a thin white line behind his right testicle and whisked him away for surgery in case it was the missing nail.
Their suspicion proved true, with the nail stuck between the top of his testicle and his penis.
Remarkably, he suffered no lasting damage to his right testicle or epididymis — the tube that stores sperm.
The nail was removed safely and the man, of Ancona, was discharged from hospital the next day.
A package centre worker had to have a missing 3/4in (1.8cm) nail removed from his scrotum after he shot himself with a nail gun in Ancona, Italy
Only one other similarly grisly scrotal injury caused by a nail gun has been reported in medical literature.
Doctors from Verona, Italy, revealed a man punctured his scrotum with a nail in 2017.
Workers rely on the tool in construction, particularly in framing and sheathing, where 70 per cent of the injuries occur.
There have also been occasional cases of chest or head injuries, which can prove to be fatal.
Scrotum ultrasounds are usually used to locate tumours and identify any source of pain in the testicles.
HOW DOES ULTRASOUND WORK?
An ultrasound scan, sometimes called a sonogram, is a procedure that uses high-frequency sound waves to create an image of part of the inside of the body.
A small device called an ultrasound probe is used, which gives off high-frequency sound waves.
You can’t hear these sound waves, but when they bounce off different parts of the body, they create ‘echoes’ that are picked up by the probe and turned into a moving image.
This image is displayed on a monitor while the scan is carried out.
Source: NHS
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In this case, the procedure was used to detect the nail, which would have otherwise remained inside the man.
Writing in Radiology Case Reports, Dr Maria Pia Pavia said the case ‘highlighted the value and role of scrotal ultrasonography in case of closed scrotal trauma’.
She said it showed all cases of injuries with sharp objects should be reviewed with ultrasounds by urologists — even if foreign objects cannot be seen from outside the wound.
Experts have said the man was lucky to have escaped without more permanent damage.
Dr Fardod O’Kelly, consultant paediatric and adolescent urological surgeon at the Becaon Hospital in Dublin, told MailOnline: ‘Nail guns are essentially responsible for sharp projectiles which penetrate various parts of the body at high speed — up to 930 miles per hour depending on the gun type.
‘To put that into context you need about 100 miles per hour to penetrate skin, and about 135 miles per hour to fracture bones.
‘The other issue is the shock wave which is produced when a projectile comes to a “sudden” stop.’
Dr O’Kelly added: ‘The patient in this report was a little unusual as he… had no obvious signs of a puncture wound on the scrotal skin.
‘He was extremely fortunate in many ways that the nail and ensuing shock wave didn’t rupture the testis which may have required the testis to be removed, or injured the urethra which could have left scarring and a large operation to repair.
‘Or even punctured the femoral vessels in the groin region which are not too far away and could have had serious consequences for him.
‘Any degree of penetrating injury — provided the patient is stable — should always be imaged with at least an ultrasound, and subsequently explored in an operation.
‘Had this patient not been explored, he would likely have developed a significant abscess (pocket of infection/pus) from the nail, which would potentially have made him very unwell, and would also require a surgical procedure.
‘It is not likely that he would have been able to get away without having this dealt with one way or another.’
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