Massive Subcutaneous Emphysema with Pneumoscrotum Following Penetrating Chest Trauma Successfully Managed with Improvised Foley Catheter Thoracostomy Drainage in a Resource-Limited Setting: A Case Report

When air escapes from the lungs or the chest cavity and gets trapped under the skin, it creates a condition known as subcutaneous emphysema. This trapped air causes the skin to swell and feel crackly to the touch, much like stepping on dry leaves. While this swelling usually stays in the neck or chest, the air can sometimes travel through the body's natural tissue layers, moving downward into the abdomen and even into the scrotum. This specific extension of air into the scrotum is called pneumoscrotum. Although the swelling itself is often just a sign of an injury, it can become dangerous if it grows large enough to restrict breathing or compress vital structures. The standard medical response is to place a tube in the chest to let the trapped air and fluid escape, allowing the lung to re-expand. However, in many parts of the world, hospitals lack these specialized tubes and the equipment needed to connect them, leaving doctors to find creative solutions when lives are at risk.

In a case report from Nigeria, a team of surgeons described how they managed a young man who arrived with massive swelling that had spread from a stab wound on his chest all the way down to his scrotum. The patient, a thirty-five-year-old man, had been stabbed in the left side of his chest two days earlier. He had first gone to a rural government hospital where the wound was stitched up, but the facility did not have the specialist equipment or staff to handle a complex chest injury. Over the next two days, the air trapped under his skin continued to build up, causing his neck, chest, arm, and scrotum to swell significantly. When he finally reached a nearby private hospital, he was in distress, with his breathing becoming shallow and his skin covering the left side of his body feeling hard and crackly. A simple X-ray confirmed that his left lung was collapsed and filled with both air and blood, a condition known as a pneumohemothorax, which was the source of the air leaking into his tissues.

The medical team faced a critical problem: the hospital did not have a standard chest drainage system, which typically consists of a thick, flexible tube and a specialized bottle to catch the fluid and air. Without this equipment, the patient could not be safely transferred to a larger hospital due to the distance, the cost of travel, and security concerns in the region. Instead of waiting, the doctors decided to improvise a solution using a Foley catheter, a tube normally used to drain urine from the bladder. They inserted a twenty-two French size catheter into the fifth space between the ribs on the left side of the chest. To make the tube work for draining air and blood, they cut small holes along its length and connected it to a standard urinary drainage bag. The valve on the bag acted as a one-way gate, letting air and blood flow out but preventing anything from flowing back in.

Once the tube was in place, the results were immediate. About two hundred milliliters of blood drained out right away, and the pressure in the chest began to release. Over the next week, the patient's breathing improved, and the massive swelling in his neck, chest, and scrotum slowly disappeared as the trapped air was evacuated. The doctors monitored him closely, and after seven days, when the air leak had stopped and his condition was stable, they removed the tube. The patient made a full recovery and returned to his normal life without any lasting problems. This case demonstrates that while standard medical equipment is ideal, a carefully constructed alternative using available materials can save a life when resources are scarce. The doctors noted that the air likely traveled from the chest to the scrotum through continuous layers of tissue that run through the body, a path that allowed the air to move freely until the source of the leak was sealed.

The report highlights that while this method worked for this specific patient, it is not a perfect replacement for standard chest tubes. The improvised tube is smaller and could potentially get blocked or kinked more easily than a dedicated medical device. The authors emphasize that this approach should only be used as a temporary measure in emergency situations where no other option exists. They also pointed out that the patient's condition worsened over two days before he received proper care, showing that injuries from chest trauma can evolve slowly and become more severe over time. In areas where advanced medical care is difficult to reach, the ability to recognize these signs and adapt available tools can be the difference between life and death. The successful outcome in this case offers a practical example of how medical ingenuity can bridge the gap when standard resources are unavailable.