Background <p>High-flow priapism is uncommon, and its association with bilateral cavernous pseudoaneurysms has seldom been reported.</p> Case description <p>This paper presents an exceedingly rare case of high-flow priapism resulting from bilateral cavernous pseudoaneurysms that developed following a straddle injury. The diagnosis was established through blood gas analysis of cavernosal aspirate, ultrasound, and magnetic resonance imaging (MRI). Digital subtraction angiography (DSA) revealed that both cavernous pseudoaneurysms were irrigated by the right internal pudendal artery. Following three months of conservative treatment, the priapism resolved; however, voluntary erectile function was not restored.</p> Conclusions <p>To the best of our knowledge, there have been no reported cases of bilateral cavernous pseudoaneurysms irrigated by the same side of internal pudendal artery. Through this case presentation, we aim to draw clinicians’ attention to this unique presentation of bilateral cavernous pseudoaneurysms perfused by a single internal pudendal artery and its potential implications for treatment approach and prognosis.</p>