Close Range Gun Shot Injury Bilateral Ruptured Testis Repair Using Tunica Vaginalis Flap

Blast testicular injury from gunshot may result in severe testicular damage and rupture, which is seen very rarely in the pediatric population. The management of these wounds is difficult and most of them result in orchiectomy. A patient with bilateral severe testicular rupture and large tunica albuginea defects due to gunshot that was repaired with tunica vaginalis flaps was presented in this study. A 16-year-old boy was administered with both ruptured testes that are located out of the scrotum. He was a sheep-man in the field and fired to kill the fox but shot himself. The first examination revealed both tunica albuginea defects and unviable tissues but normal blood supply in testes. He was taken to the operating theatre and the exploration revealed a bullet hole in the cranial portion of the scrotum on the left side of the penis. Tunica albuginea defects were severe and primer closure could not be achieved; however, defects were minimized with a few primer sutures on the tunica albuginea edges. Not to sacrifice the viable testicular tissue for closing the tunica albuginea, tunica vaginalis flaps were prepared and sutured to the remaining edges with absorbable sutures. At his fourth-month follow-up, Doppler ultrasound revealed normal blood supply of both testes. Severe testicular rupture with tunica albuginea defect sometimes could not be closed primarily without excision of viable testicular tissue. In these cases, the vascularized tunica vaginalis flaps provide an alternative method of closure for bilateral testicular injury in pediatric patients.