A 24 year-old African American man presented to the emergency department following a single high velocity gunshot wound to the right thigh and scrotum. He reported no other past medical or surgical history, took no medications, and denied tobacco, alcohol or illicit drug use.

On physical examination he was hemodynamically stable and had no associated abdominal or chest injuries. His phallus was normal and without injury. There was no blood at the urethral meatus, and he reported being able to urinate. He had a single entrance and exit wound in his right hemiscrotum with ecchymosis, making examination of the testicles difficult.

The case was prepared by Nicole Uzzo, Curran Uppaluri, MD, Laura McGarry, DO, and Jay Simhan, MD, from the Einstein Healthcare Network in Philadelphia, Pennsylvania.

Dr Uppaluri and Dr McGarry are urology residents. Dr Simhan is vice chairman of the department of urology and director of urologic trauma, reconstruction, and prosthetics.

Figure 1 – a midline scrotal exploration revealed significant bilateral testicular trauma from a single gunshot wound. There was no associated intra-abdominal trauma. Significant hematoma and violation of the tunica albuginea with extravasation of seminiferous tubules are noted from the left testicle.
Figure 2 – Primary surgical repair was not possible with either testicle. The left testicle was removed given the extent of injury. The right underwent repair and salvage using an ipsilateral tunical vaginalis flap.
Figure 3 – Exploration using a scrotal midline incision provides the greatest flexibility. Drainage decreases the risks of post op scrotal hematoma.
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