Hair Coil Strangulation of the Penis

Assistant Professor, Department of Pediatric Surgery, Dr BC Roy Memorial Hospital for Children,
111, Narkeldanga Main Road, Kolkata 700 026, West Bengal, India.
Email: [email protected]
 

A five-year old boy presented with symptoms of itching and pain in the phallus, especially at night, for the last 3 months. The caregivers had noticed a progressively developing scab located just proximal to the glans. The child had been seen by several practitioners who gave local antibiotic ointments. Since the last two weeks, the child had been passing urine partly from the affected area. On examination, there was no penile edema or discharge, and only a fibrotic groove proximal to the glans with a scab. Once the scab was elevated, hair coil strangulation of the penis with the offending hair could be seen (Fig. 1). There was also a partial disruption of the urethra.

Fig. 1 Hair coil injury with partial transaction of the urethra.

Hair coil strangulation or penile tourniquet injury is a rare and potentially devastating condition that has been reported mainly in circumcised children. The hair is thought to belong to the patient, and a majority of cases are believed to be accidental although in select cases, child abuse should be suspected. Hair is extremely thin, has high tensile strength and is easily overlooked especially in the presence of a foreign body reaction. Moreover, hair stretches when wet and shortens when dried, which makes it an efficient tourniquet. Both superficial, and more commonly, deeper injuries such as transection of the urethra and partial or complete amputation of the glans has been reported, necessitating repair of varying degrees of complexity. Awareness of the condition, with early detection and removal of the offending coil of hair can prevent these complications.