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Open Access Highly Accessed Case report

Bilateral testicular self-castration due to cannabis abuse: a case report

Mustapha Ahsaini1*, Fadl Tazi1, Abdelhak Khalouk1, Karim Lahlaidi1, Abderahim Bouazzaoui2, Roos E Stuurman-Wieringa3, Mohammed Jamal Elfassi1 and My Hassan Farih1

Author Affiliations

1 Department of Urology, Hospital University Center Hassan II, 30000 Fez, Morocco

2 Department of Anesthesia and Intensive Care Unit, Hospital University Center Hassan II, 30000 Fez, Morocco

3 Department of Urology, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands

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Journal of Medical Case Reports 2011, 5:404  doi:10.1186/1752-1947-5-404

Published: 23 August 2011

Abstract

Introduction

The self-mutilating patient is an unusual psychiatric presentation in the emergency room. Nonetheless, serious underlying psychiatric pathology and drug abuse are important background risk factors. A careful stepwise approach in the emergency room is essential, although the prognosis, follow-up, and eventual rehabilitation can be problematic.

We present a unique and original case of bilateral self-castration caused by cannabis abuse.

Case Presentation

We report a case of a 40-year-old Berber man, who was presented to our emergency room with externalization of both testes using his long fingernails, associated with hemodynamic shock. After stabilization of his state, our patient was admitted to the operating room where hemostasis was achieved.

Conclusion

The clinical characteristics of self-mutilation are manifold and there is a lack of agreement about its etiology. The complex behavior associated with drug abuse may be one cause of self-mutilation. Dysfunction of the inhibitory brain circuitry caused by substance abuse could explain why this cannabis-addicted patient lost control and self-mutilated. To the best of our knowledge, this is the first case report which presents an association between self-castration and cannabis abuse.