Bilateral Testicular Evisceration Sequel to Trauma: Challenges of Management in Emergency Department

The Genitourinary (GU) tract injury is rare with an annual incidence of less than one percent. We present a rare case of traumatic degloving injury of male external genitalia with complete evisceration of bilateral testicles following motor vehicle accident. Case description 29-year-old lorry driver was brought to Emergency department following head-on crash of his lorry into a ravine resulting in chest, abdomen and pelvis slamming onto dashboard. The driver was trapped for 4.5 hours. On arrival, he was conscious but hemodynamically unstable. Clinical examination and Focused Assessment with Sonography in Trauma (FAST) was suggestive of left pneumothorax and no evidence of intraabdominal injury. Chest tube was inserted. Genital examination showed scrotal degloving wound with complete evisceration of bilateral testis. He also sustained open fracture of right tibia, fibula and left inferior pubic rami fracture. Upon stabilization, was sent for operation and intraoperatively found to have bilateral testicular rupture. He underwent scrotal exploration, and bilateral orchidopexy. Postoperatively, multiple dialysis sessions were done for rhabdomyolysis. Hormonal study yielded low levels of testosterone. He was discharged home after 2 weeks with testosterone pills. Discussion Challenges in Emergency Department setting would be prompt identification and management of life-threatening injuries along simultaneous management of degloving external genitalia injury and associated injuries. FAST and extended FAST play a key role in managing life threatening conditions. Conclusion Total evisceration of bilateral testis injury are rare. Although not life threatening, should be treated promptly and thoroughly in order to avoid long-term functional and psychological damage.