A case report of a severe firearm-related ballistic injury to the external genitals in an adolescent with a favorable outcome in a resource-limited setting

Introduction: A ballistic wound to the external genitalia is a penetrating injury to the external genitalia caused by a firearm projectile. Although rare, these wounds can be serious enough to compromise urogenital function. This article reports a case that illustrates this point. Case presentation: A 14-year-old boy was admitted with acute urinary retention secondary to open trauma to the external genitalia caused by a firearm projectile. Injury assessment revealed a devastating wound to the external genitalia, with urethral rupture and partial sectioning of the corpora cavernosa. The patient underwent urethral and cavernous repair with closure and a drain blade. The postoperative course was uneventful, with no urogenital sequelae. Clinical discussion: Ballistic wounds to the external genitalia are rare but increasingly common in areas of armed conflict. Whether isolated or associated with other injuries, they primarily affect young people and can present in various forms. There are general principles for the surgical management of ballistic wounds, but no universal consensus. Intraoperative findings, therefore, guide surgical procedures. The aim is to avoid postoperative complications, including surgical-site infection and functional sequelae, particularly of erectile function, which poses a medico-legal problem. Conclusion: The search for urethral, cavernous, and testicular injuries during surgical exploration must be systematic and performed as early as possible in all cases of firearm-related penetrating wounds to the male external genital organs. It is a surgical emergency, and the surgical procedure must preserve the functional prognosis as much as possible.