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Background
We considered this case to be important for two reasons. First, scrotal swelling may be caused by an intra-abdominal injury with haemorrhage or free fluid within the abdominal cavity which then tracks through a patent processus vaginalis. Although this is uncommon, it is important not to miss as these injuries could cause significant morbidity or mortality. Second, the patient had had a focused assessment with sonography for trauma (FAST) scan which failed to demonstrate the injury. Although the outcome in his case was excellent, it may not be for other patients where a 'FAST negative' is reported.
Case presentation
A fit and healthy 40-year-old gentleman presented to A&E after being kicked by a horse in the lower left side of his chest ( figure 1 ). He was haemodynamically stable and complaining only of pain at the site of the kick. FAST scanning was negative and he was discharged. He presented again 2 days later with pain and swelling in the right hemiscrotum. He reported no abdominal pain; on examination, his abdomen was soft and non-tender but he remained tender over the area of the kick to his chest. Clinical examination ruled out torsion, and he was discharged with analgesia and a 2-week appointment for an ultrasound....