A 47-year-old Dutch tourist narrowly missed losing his testicles in South Africa, after a cobra bit him whilst he was sitting on the toilet.
The snouted cobra (Naja annulifera) bit the man while he was holidaying on a nature reserve in SA. Apparently he spotted the snake at the bottom of the toilet bowl just as he sat down… but it was too late; and he had to be flown 350km by helicopter to the nearest trauma center, where he was diagnosed with ‘scrotal necrosis‘ (death of the tissue on the scrotum).
Unfortunately he had to wait three hours for the helicopter, during which time his penis basically began to rot. He “felt a burning sensation in his genitals and a pain that ascended through his groin to his flank, upper chest, and abdomen. He also reported vomiting but no neurological symptoms”, said the authors of an open access article on Science Direct.
“His penis and scrotum were noted to be swollen, deep purple in color, and painful on hospital admission,” said the authors, who said theirs is the first case describing ‘Naja annulifera envenomation‘ (cobra venom poisoning) of the genitals.
The man was admitted to intensive care and immediately treated with eight doses of non-specific snake venom antiserum and broad-spectrum antibiotics; and also required some hemodialysis due to acute kidney injury over a seven-day period in hospital.
Once he’d stabilised, the patient underwent a surgical debridement (cleaning a wound of dead tissue etc), and after nine days was repatriated to the Netherlands for further treatment. The authors of the Science Direct article, who treated him in the Netherlands – including applying a “full-thickness graft (which) was harvested from the groin and placed over the penile defect” – say he has since made a full recovery.
They say the man’s genital function and esthetics of his penis had a good chance of recovery thanks to early treatment.
In the man’s latest follow-up – which is one year since the incident – the medical team says: “At 1 year follow-up, the wounds had healed well (Fig. 3), and penile function and sensation had fully recovered. Because of a pulling sensation on the scars, the plastic surgeon performed a Z-plasty. Renal function remained slightly impaired (eGFR, 52 mL/min/1.73m2) and is under nephrology follow-up.”
Fig. 1: Scrotal wound and penile edema on arrival in the Netherlands.
Fig. 2: Full-thickness graft on the penile shaft six days after surgical debridement.
Fig. 3: Penile shaft one year after the full-thickness graft.
For the team in the Netherlands, this has been an incredibly rare opportunity to treat a man with a cobra bite. Last year the country’s poisoning center only received 37 calls about snake bites, with less than half needing snake venom antisera. However, snake bites cause 81,000–138,000 deaths and a further 400,000 disabilities worldwide each year… and the authors believe these numbers are actually higher because incidents in rural areas are underreported.
In conclusion the researchers say: “Snake bites usually occur on the extremities, with few reports of bites to the genitals (all received the antidote, three required surgical debridement, and all made full recoveries). Ours is the first case describing N. annulifera envenomation of the genitals.”
They say their take home message is: “Always flush the toilet before sitting down in countries notorious for their snake population!”