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

Abstract

IntroductionThe 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 PresentationWe 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.ConclusionThe 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.

Self-Mutilation of Genitalia Masquerading as Suicide: A Rare Case Report

“…Schizophrenia, secondary to delusions and hallucinations cause self-injurious behavior most cases of genital self-mutilation reported in the literature have been in psychotic patients with either functional or organic brain disease [5,14]. Our case is an unusual type of genital self-mutilation in patient suffering from depression without any psychotic features [8,10]. Here in, we report a case of 28 year old male patients suffering from major depressive disorder without psychotic features from the last six month, who presented to us with self-mutilation of genitalia (penis, with both testes and scrotum).…”

“…Psychotic illness includes command hallucinations in schizophrenias patients, bipolar affective disorder with psychotic features and borderline personality disorder [5]. Gender dysphoria, male identification, guilt for sexual offences, sexual conflicts and offences, erotic purposes and body image preoccupation are the other psychopathologies proposed for genital self-mutilation in nonpsychotic illnesses [8].Various syndromes like Lesch-Nyhan syndrome, Cornelia de Lange syndrome and syndromes associated with mental retardation are the other important causes of selfmutilation [9].The rare causes of genitalia self-mutilation are cannabis and cocaine abuse, alcohol intoxication, and amphetamine use [8,10]. Combined mutilation of both penis and scrotum has been reported in patients with command hallucinations and religious delusions [4].…”

Genital Self-Mutilation Patient without Diagnosed Psychiatric Disorder: A Multidisciplinary Approach

“…Self-mutilation behavior is being increasingly observed (Ahsaini et al, 2011) and is quite challenging to treat due to the numerous etiologies and complications. The management of urological injuries, a detailed psychiatric evaluation and treatment of hypogonadism should be carried out to ensure the best prognosis for this kind of patient.…”

Self-Cannibalism: The Man Who Eats Himself

“…Erdur et al reported a 27-year-old patient with schizophrenia who amputated his tongue and penis 1. Ahsaini et al published a report of a 40-year-old man who presented in hemodynamic shock after eviscerating both testes with his fingernails 8. Michopoulos et al reported a 66-year-old man who had been mutilating his fingers for the last six years 5.…”