A Traumatic Case of the Scrotum by Firearm and with a Dramatic Evolution

Gunshot wound is rare on the testicles and involves the patient’s reproductive function. The authors report a case of open gunshot wound trauma to the testicles in a 45-year-old patient with no particular information, except, living with two women and eight children. Emergency sharing noted a fracture of the right testicle with damage of the cord components. After the surgery, the left testicle was necrotic, so a left orchiectomy was performed. The aftermaths of this second surgery were simple. However, the management of this hunting accident resulted in castration, which poses the problem of the patient’s sex-uality.


Introduction
Gunshot wounds, defined as any wound produced on the human body by the approach or impact of a firearm, are generally rare, whether they are wounds caused by weapons of war or projectiles in a civilian context [1]. Such gunshot wounds are much rarer on the testicle and involve the patient's reproductive function [2]. This is a report of gunshot wound to the testicles.

Observation
He is a 45-year-old patient, a hunter, with no particular information, except, living with 2 women and 8 children all alive and in apparent good health. He Center for open gun trauma after a hunting accident that occurred six hours before his arrival in our center.
The patient had inadvertently pulled the trigger of his shotgun while using a buckshot. Physical examination had shown a dilapidated and hemorrhagic wound of the scrotum exposing the fractured right testicle with no exit orifice ( Figure 1), the contralateral testicle was difficult to examine. There was swelling of the penis ( Figure 2). There was no urethroorrhage, urine retention, or hematuria.
Radiography of the pelvis had shown numerous rounded foreign bodies reminiscent of buckshot on the testicles with dispersion of some projectiles in the surrounding tissues. The bony frame was free of any fracture lesions. Surgical exploration had noted the presence of foreign bodies ( Figure 3 and Figure 4), the right testicle fractured with lesion of the spermatic cord vessels, the contralateral testicle was macroscopically healthy. It was trimmed with a right orchiectomy.    Antibiotics and anti-inflammatory medicines were introduced postoperatively.
The postoperative period was marked by necrosis of the remaining testicles even (7) days after the first orchidectomy which was treated by a left orchidectomy.
After a 4-month follow-up, the patient did not have an erection.

Discussion
Gunshot wound trauma on testicles is an uncommon accident. The different series of publications concern a small number of patients; case [3] reports the largest series (64 cases in 20 years) and Barthelemy (33 cases in 10 years) [4].
Other publications concern a certain number of patients, between 6 cases for Mac Dermott [5] and 53 cases for Altarac [6]. Traumas are even rarer than when they are caused by firearms [7]. This rarity has been noted by Bah et al. ( The mechanism of injury in firearm wounds makes it possible to distinguish between civilian practice wounds, and war injured which are more severe and extended [11]. In this case, the wound was in a civilian context. These accidents are due to a lack of control over weapons and their ammunitions, either through acts of torture or revenge in the case of Mianne et al. [7].
We can explain the occurrence of trauma in our patient by the fact that in our regions and villages, hunting weapons are not conventional, because they are manufactured by the owner himself. The average age of the traumas of the testicles varies between 10 and 37 years [4] [8] [9] [10] [12]. For these authors, this young age is explained by the fact that this is the active layer of the population, and therefore more exposed to trauma. In our case, the patient is 45-year-old and in addition to the reasons reported in the literature review, his profession could also expose him to these types of trauma.  [8].
For our patient this option had been proposed to him, but he did not consider

Conclusion
Gunshot wounds are rare. They are severe and are prognostic for reproduction.
The patient must therefore be warned of possible castration and the consequences of this.

Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this paper.