Archives of International Surgery

CASE REPORT
Year
: 2019  |  Volume : 9  |  Issue : 1  |  Page : 10--12

Delayed presentation of Penile tourniquet syndrome due to hair coil as complete urethral transection: A devastating complication


Amit Kumar, Rashi, Amit K Sinha, Bindey Kumar, Sambedna 
 Department of Pediatric Surgery, AIIMS, Patna, Bihar, India

Correspondence Address:
Dr. Rashi
Department of Pediatric Surgery, AIIMS, Patna - 801 507, Bihar
India

Abstract

Penile tourniquet syndrome (PTS) is a condition in which a hair coil is wrapped around the penis causing damage to the urethra and penis. The spectrum of complications due to PTS may range from simple oedema of the penis to complete penile necrosis. We are reporting an 8-year-old boy who presented late to us with complete urethral transection having history of hair coil around penis 3 years back. Examination of the external genitalia revealed complete urethral transection at the coronal sulcus and deeply grooved cut mark at the dorsal part of the glans. The coronal sulcus was shallow and the glans overhanging. The urethral defect was about 0.5 cm. Following evaluation the patient underwent urethral repair by end to end anastamosis and was able to pass urine through the native urethral meatus postoperatively. Most of the cases reported in literature presented soon after the urethral injury unlike the index case which was discovered after 3 years.



How to cite this article:
Kumar A, Rashi, Sinha AK, Kumar B, Sambedna. Delayed presentation of Penile tourniquet syndrome due to hair coil as complete urethral transection: A devastating complication.Arch Int Surg 2019;9:10-12


How to cite this URL:
Kumar A, Rashi, Sinha AK, Kumar B, Sambedna. Delayed presentation of Penile tourniquet syndrome due to hair coil as complete urethral transection: A devastating complication. Arch Int Surg [serial online] 2019 [cited 2020 Aug 4 ];9:10-12
Available from: http://www.archintsurg.org/text.asp?2019/9/1/10/282574


Full Text



 Introduction



Penile hair tourniquet syndrome (PHTS) is a rare urologic emergency characterized by a progressive hair coil penile strangulation commonly occurring in children.[1] This may result in partial or complete obstruction of circulation leading to ischemia of the strangulated organ. PHTS has been reported in both circumcised and uncircumcised penises.[2] If not diagnosed and treated promptly, complications including urethrocutaneous fistula, complete urethral transection, penile gangrene, and penile amputations may be the final outcome.[2] In this paper, we present our experience with the diagnosis and treatment of an 8-year-old boy with a complicated hair coil penile strangulation.

 Case Report



An 8-year-old boy presented to the outpatient department with complaints of passage of urine from the under surface of penis in the last 3 months. The mother gave a history that she had removed a hair piece coiled around the coronal sulcus of the boy's penis. The hair coil was wrapped on the penile shaft for unknown period of time before it was discovered and removed by the mother. The child also went for ritual circumcision at the age of 5 years. There was no excessive bleeding or micturating through abnormal orifice soon after circumcision. On local examination, the genitalia showed a complete urethral transection at the coronal sulcus and deeply grooved cut mark at the dorsal part of the glans which was not present at birth. Coronal sulcus was shallow and the glans was overhanging [Figure 1]. Routine blood investigation of patient was done and planned for surgery. During operation a 6 Fr infant feeding tube was negotiated from the meatus and passed through the damaged urethra up to bladder [Figure 2]. The gap between damaged urethral ends was about 0.5 cm. There was no penile chordee. After this penile degloving was done to expose both ends of the damaged urethra. Urethral mobilization was done from both the ends. End to end urethral anastomosis was done with 6-0 vicryl in interrupted fashion over 6 Fr silicone catheter. Sub-dartos flap was created and placed over repaired urethral anastomosis as second layer [Figure 3]. Finally, skin cover was provided. After this sterile dressing was done. Dressing was opened on fourth post operative day and silicone catheter was removed on 10th post-operative day. Patient was able to pass urine from the native meatus with good stream. There was no urethro-cutaneous fistula. Patient was discharged home on 11th post-operative day and kept on regular follow up.{Figure 1}{Figure 2}{Figure 3}

 Discussion



The term Hair tourniquet syndrome was first described by Quinn (1832).[1] It is characterized by circumferential strangulation of body appendages like penis, toes, and fingers by hair or any fiber leading to pressure necrosis or transection.[2] Penile Tourniquet Syndrome (PTS) due to hair coil around penis is commonly seen in infants and circumcised males between 0 and 6 years of age.[3] It can be accidental, intentional or as a result of child abuse.[4] As per literature PTS is common in infants of mother with excessive hair loss (telogen effluvium).[5] Delayed presentation of PTS can lead to various degree of injury including urethral transection and penile amputation. So, early diagnosis and prompt treatment is very important.[6]

In our case the patient was 8 years old and its presentation was delayed. Patient was planned for elective operation and end to end urethral anastomosis was done with 6-0 vicryl successfully. There were no post-operative complications.

 Conclusion



PTS is a potentially devastating condition to patient as well as to the parents which may result in serious complications like urethral transection and even penile amputation. It requires a high degree of clinical suspicion to diagnose this condition early and prompt intervention to halt further damage.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Quinn NJ. Toe tourniquet syndrome. Pediatrics 1971;48:145-6.
2Singh V, Singh P, Sharma A, Sarkar J. Acquired constriction ring syndrome as a cause of inconsolable cry in a child: A case report. Cases J 2008;1:92.
3Badawy H, Soliman A, Ouf A, Hammad A, Orabi S, Hanno A. Progressive hair coil penile tourniquet syndrome: Multicenter experience with 25 cases. J Pediatr Surg 2010;45:1514-8.
4Barton DJ, Sloan GM, Nichter LS, Reinisch JF. Hairthread tourniquet syndrome. Pediatrics 1988;82:925-8.
5Strahlman RS. Toe tourniquet syndrome in association with maternal hair loss. Pediatrics 2003;111:685-7.
6Saad AZ, Purcell EM, McCann JJ. Hair-thread tourniquet syndrome in an infant with bony erosion: A case report, literature review, and meta-analysis. Ann Plast Surg 2006;57:447-52.