Case Report: Penile Strangulation Secondary to Hair Tourniquet

Abstract

Penile strangulation is a rare condition in children caused by circumferential constriction of the coronal sulcus by constricting material, commonly thin maternal hair. Vague presenting symptoms often makes diagnosis difficult, but delay in diagnosis can lead to a variety of severe complications including urethral injury and penile necrosis. Providers must have a high index of suspicion and carry out a careful examination to identify maternal hair strands that may bury deep within penile edema. We describe two cases of penile strangulation secondary to maternal hair strands that were successfully treated with thorough examination and division of the constricting hair in the emergency department. In both cases, presentation involved penile swelling and erythema which was noticed by caregivers. Once the diagnosis has been made, urgent treatment using depilatory cream or mechanical removal must occur, with urgent referral to specialists if unable to remove to constricting material. Caregivers must also be counseled on appropriate steps to prevent penile hair tourniquet syndrome. Devastating complications can be avoided by early recognition and proper management of the syndrome, but providers must have knowledge of the condition and a high index of suspicion.

Penile Hair Tourniquet Syndrome (PHTS): A Case Report of a Two-Year-Old Boy

“…If it goes unrecognized, the condition can lead to devastating complications [ 2 ]. It is easily preventable, and when recognized early, it can be treated simply by removal of the coil under local anesthesia [ 3 ]. The problem is lack of awareness: PHTS usually goes unnoticed because most primary care providers, such as pediatricians, emergency pediatric physicians, and pediatric surgeons, are not fully aware of the condition [ 1 , 4 ].…”

“…The first case was reported as early as 1832, but, surprisingly, the condition still has not received the recognition it deserves. It is barely mentioned in textbooks, although numerous case reports have been published in the literature [ 3 – 5 ].…”

“…The hair becomes buried in the skin and is difficult to detect with the naked eye. A high degree of suspicion and awareness is therefore essential [ 3 , 4 ]. Magnifying glasses or loupes are useful aids for detecting the constricting hair coil [ 3 ].…”

“…A high degree of suspicion and awareness is therefore essential [ 3 , 4 ]. Magnifying glasses or loupes are useful aids for detecting the constricting hair coil [ 3 ].…”

“…The hair gets wrapped around the coronal sulcus of a circumcised child, leading to a spectrum of clinical situations ranging from mild swelling and redness of the glans to more serious complications such as urethro-cutaneous fistulas, gangrene, and penile amputation [ 2 ]. We are reporting this case because a delay in diagnosis—due to a lack of awareness among general practitioners, or uncareful examination—can lead to devastating complications [ 3 ].…”