A man has suffered from scrotal necrosis – or death of tissue on the scrotum – after a snake bit his genitals while he was on a relaxing (until that point) holiday in South Africa.
The 47-year-old from the Netherlands was staying on a nature reserve when, "while toileting," a snake "struck from the toilet and bit his genitals," his doctors write in Urology Case Reports. Being far from a hospital, he had to wait for three hours to be airlifted to the nearest trauma center. In the meantime, the toilet snake was identified as a snouted cobra (Naja annulifera).
The snake, while not usually aggressive, will stand its ground if it feels cornered – say, if someone's buttcheeks and genitals are blocking their exit from a toilet.
Before he arrived at the hospital, the patient experienced pain all the way from his groin to his upper chest, plus a burning sensation in the unfortunate genitals themselves. Though the venom of the snake is neurotoxic, he was lucky enough to avoid any neurological symptoms – though luck is relative when you've been bitten on the penis hours away from medical attention.
Upon arrival in hospital, he was fully conscious, had developed a fever, and "had swollen genitals with a deep purple discoloration, indicating scrotal necrosis". Eight doses of venom antiserum were administered and he was transferred to intensive care, where he required dialysis for acute kidney injury before he stabilized.
The necrosis in his genitals stabilized too, at which point the medical team performed a surgical debridement, removing the dead tissue. There are,of course, images in the case report, though we'd advise against looking at them.
Now that you're back, here is the happy ending. After being transferred to the Netherlands, his team was able to remove more dead tissue, before performing a successful graft on the man's penis and scrotum, replacing the dead tissue with tissue taken from his groin. A year later, his wounds had healed nicely, and he had full sensation in his penis.
In even better news, he had the dubious honor of becoming the first case of N. annulifera envenomation of the genitals described in the medical literature.
"Our take home message?" the team conclude in their report. "Always flush the toilet before sitting down in countries notorious for their snake population."