Massive scrotal and abdominal subcutaneous emphysema secondary to intrascrotal heroin injection: A case report

This case report presents a rare instance of massive scrotal and abdominal subcutaneous emphysema resulting from self-injection of heroin. A 50-year-old incarcerated male exhibited painless scrotal swelling with extensive crepitus but no signs of infection or systemic toxicity. Imaging confirmed subcutaneous gas accumulation without visceral perforation or necrotizing fasciitis. Surgical exploration ruled out purulence or tissue necrosis, and the patient later admitted to intrascrotal heroin injections. The discussion underscores the importance of considering self-induced causes in diagnosing scrotal emphysema, particularly in high-risk populations. Early imaging, surgical evaluation, and psychiatric involvement are essential for optimal management.