Penile hair coil strangulation in a 9-year-old patient: Surgical management and review of the literature

Abstract

Introduction Strangulation of the penis is a rare situation that requires urgent treatment for penile decompression. The complications could range from simple edema to severe ones such as urethrocutaneous fistula, complete urethral transection, penile gangrene and penile amputation. This work has been reported in line with the SCARE criteria. Case presentation A 9-year-old patient was presented to the emergency service.During examination of the genitals, the glans was hanging to the penis by a very slim pedicle, its coloration was normal and the urethra was almost cut at the sulcus coronarius. The cause of strangulation was multiple hair coils.We performed single stage reparation which consists of refreshing the edges of the urethra and glans, followed by anastomosing the two cut urethral ends, reinforcement by interposing a well vascularized dartos layer was also performed. At the six months follow-up, the penis had a good cosmetic outcome and the glans sensation was present. Discussion The penile tourniquet syndrome is one of the major causes of pediatric penile trauma. Ritual circumcision is basically the main cause of the series followed by penile strangulation. Surgical reparation can be performed in one or two stages. It should be performed by a surgeons experienced in hypospadias repair by following the same principles of dissection and applying a second layer coverage for the urethroplasty. Conclusion Hair-coil penile strangulation is an uncommon condition. The repair can be realized in one or two stages but it must be performed by a surgeon experienced in hypospadias surgery. Early surgical repair is required to achieve successful results.

Hip Pain and Change in Gait in a 7-Year-Old Boy

“…Repair of more serious injuries varies from debridement to urethroplasty to multi-stage reconstruction. 10,11 Close follow-up is warranted for all cases.…”

Hair coil strangulation of the penis in children: Single center experience in a decade.

“…Jennifer and Jean reported 1 case of penile strangulation in a 30 year old man with coronal urethrocutaneous fistula due to a neglected condom ring on the coronal sulcus (11). Bouassida and coworkers reported a single case of penile hair coil strangulation in a 9 year old circumcised boy (12) while Qamar from Pakistan reported 15 cases in 27 years caused by hair and thread (13) . We are not aware of the exact number of children who presented to our outpatient clinic in the decade 2010-2020, but the rough estimate is more than 11,000 children.…”

Acute preputial strangulation secondary to hair tourniquet syndrome

“…Hair tourniquet syndrome is a subcategory of penile strangulation often seen with hair wrapped around the coronal sulcus, thereby functioning as a tourniquet. In the literature, various complications related to longstanding strangulation have been reported such as urethrocutaneous fistulae, complete urethral transection, penile gangrene, and penile amputation 1,4–7 . Prevention is easier the earlier the correct diagnosis is acknowledged because worsening edema obscures the hair and renders its removal a difficult task.…”

“…In the literature, various complications related to longstanding strangulation have been reported such as urethrocutaneous fistulae, complete urethral transection, penile gangrene, and penile amputation. 1,[4][5][6][7] Prevention is easier the earlier the correct diagnosis is acknowledged because worsening edema obscures the hair and renders its removal a difficult task. Hair tourniquet syndrome is rare, and thus awareness of its existence as a differential diagnosis is important when encountering patients with penile edema and urinary symptoms, as prompt diagnosis and proper management is vital to ensure that it does not lead to severe complications.…”