A hair or filament that wraps around the penis can lead to a surgical emergency. The constricting band will impair distal venous and lymphatic drainage causing more edema and further impairing drainage. The ultimate sequela is arterial compromise and amputation. This is most commonly seen in young children, although it has also been reported in men who use penile rings or constrictors.
Management and Disposition
Immediate release of the constriction generally gives relief and restores any impaired circulation. Take care not to injure any underlying structures. If the edema is so great that the constricting band cannot be easily released, obtain emergent urologic consultation.
Edema may obscure the hair or filament and bury it subcutaneously.
Measures to decrease the swelling, such as direct pressure and ice packs, may facilitate visualization and incision of the tourniquet.
Clitoral tourniquets have been described.
Penile tourniquet should be considered when presented with a fussy infant.
Penile Tourniquet. Penile engorgement due to self-inflicted tourniquet in a prepubescent boy. (Photo contributor: Lawrence B. Stack, MD.)