03 Hair-Thread Tourniquet Syndrome in A Child Penis - Case Report and Review of Literature-1

ISPUB.
COM The Internet Journal of Urology

Volume 6 Number 1
Hair-thread tourniquet syndrome in a child penis: Case

report and review of literature
H Al-Hazmi, A Ali, T Al HArbi, B Almussallam
Citation
H Al-Hazmi, A Ali, T Al HArbi, B Almussallam. Hair-thread tourniquet syndrome in a child penis: Case report and review
of literature. The Internet Journal of Urology. 2008 Volume 6 Number 1.
Abstract
Hair-thread tourniquet syndrome is a general term that refers to a constriction injury resulting from a strand of hair or a thread
wrapped tightly around an appendage. The condition usually occurs in very young patients in the first few months of life. [1] We
present a unique case of a 4 year and 6 month old baby boy with hair-thread tourniquet syndrome penis that can present a
diagnostic dilemma to someone who is unaware of the condition, because the constricting agents are frequently difficult to see.
Early recognition and a definitive treatment are of paramount importance in order to avoid irreversible ischemia and possible
urethral transaction and even auto-amputation. Although most cases reviewed are mostly accidental, Nonaccidental injury must
consider in a minority of cases.
INTRODUCTION Figure 1
Hair-thread tourniquet syndrome is a rare condition that Figure 1: Shows circumferential ulcer at coronal sulcus and
no foreign body can be seen
occurs mostly in babies. It occurs when a strand of hair or
occasionally a piece of thread or fiber encircles an
appendage, causing partial or total obstruction to circulation.
CASE REPORT
4 years and 6 months old boy who is previously healthy with
no previous surgery except circumcision under local
anesthesia at age of 7 days, presented to emergency
department with irritability during voiding urine for the last
two weeks and mild penile swelling and coronal sulcus ulcer
with crustation in the last 2 days. He has a history of
nocturnal enuresis but No history of trauma, foreign body,
and allergy. On examination, the patient was irritable, in
Our impression at that time was foreign body; a burred hair-
pain, there is mild distal penile swelling, and erythematic
thread strangulating the glans, putting in our mind possibility
and tender circumferential constriction linear fissure at
of child abuse. Child was urgently taken to theatre;
coronal sulcus and foreign body cannot see. {Fig 1}
Examination Under general anesthesia shows a Constriction
ring of hair-thread like fibers at the glans penis sulcus and
was removed with a pair of fine scissors {Fig 2}
1 of 4
Hair-thread tourniquet syndrome in a child penis: Case report and review of literature
Figure 2 DISCUSSION
Figure 2: Intraoperative finding of hair Constriction ring: Hair tourniquet syndrome is characterized by circumferential
Upper picture is the before and lower picture after hair
strangulation of an appendages or genitalia by human hairs
removal it is 6 cm long, faint yellow in color
or fibers. The condition first described in 1832 and Quinn is
the first coined the term hair tourniquet syndrome in 1971.
[2]
According to Saad et al; there were reviewed a total of 210

reported cases and they found that penile involvement
occurred in 44.2%, toes in 40.4%, fingers in 8.57%, and
other sites (female external genitalia, uvula, and neck) in
6.83% of cases. Penile tourniquet is more common in
patients around 2 years old. [3]
Hair remains the most common causative agent with a

reported incidence of 79% in one study. Hair has unique
physical characteristics that make it an ideal tourniquet. It is
thin, elastic and expansible when wet while constricts as it
dries off without losing its tensile strength. [2]
The urethra examined and was not injured {Fig 3}. Delayed diagnosis may result in loss of appendages in some
cases. [3] In our case, the patient presented late because he
Figure 3
treated for 2 weeks as a case of acute balanitis. Early
Figure 3: post-removal of hair tourniquet, shows no urethral
injury recognition of this condition is important and requires a high
index of suspicion when no other causes found in an irritable
infant.
Haddad, in his detailed review of penile strangulation, has

divided the etiology into 4 groups. They are accidental,
incidental, intentional, and undetermined cause. He also
mentions circumcision as a predisposing factor as a hair is
more easily entangled around a circumcised penis than
around a glans covered by an intact prepuce. [3]
Our patient has nocturnal enuresis and he is 4 year and 6

month old; some instances of penile wrapping for control of
nocturnal enuresis have reported. [4]
Hair- thread tourniquet syndrome usually occurs in infants

and is presume to be accidental. However, Barton et al., in
1988, reported a case of hair- thread tourniquet syndrome
due to child abuse [5]. In our case, the patient presented with
his mother only and not came back for follow up but our
Postoperative patient was doing well voiding urine without
social worker involved and excluded child abuse.
difficulty. The Social worker was involved to rule out child
Nonaccidental cause should consider carefully in certain
abuse but no definite data collected from the family pointing
cases as mistake and misjudgment have recorded in the past.
any social problem. The patient was discharge home first
There are several reports in the literature where the diagnosis
postoperative day and Follow up appointment after two
of child abuse has been overturned. [3]
weeks given to the patient but the patient didn’t show at
follow up.
2 of 4
CONCLUSIONS 2. Singh V et al. Acquired constriction ring syndrome as a

cause of inconsolable cry in a child: a case report. Cases
Hair-thread tourniquet syndrome especially in the penis is an Journal 2008, 1:92
uncommon but serious entity that need high index of 3. Saad AZ, Purcell EM, McCann JJ. Hair-Thread
Tourniquet Syndrome in an Infant with Bony Erosion- a
suspicious. Early diagnosis and prompt treatment can save Case Report, Literature Review, and Meta-analysis. Ann
the patient from unwanted complications. Nonaccidental Plast Surg 2006; 57: 447–452.
4. Bacon JL and Burgis JT. Hair Thread Tourniquet
cause should considered carefully in certain cases Syndrome in Adolescents: A presentation and review of the
literature. J Pediatr Adolescent Gynecology (2005)
References 18:155–156
1. Ram RM, William EB, Gary HB.Hair-thread tourniquet 5. Okeke LI. Thread embedded into penile tissue over time
syndrome in a cognitively impaired nursing home resident. as an unusual hair thread tourniquet injury to the penis: a
Advances in Skin & Wound Care Sep 2004. case report. Journal of Medical Case Reports 2008, 2:230
3 of 4
Author Information
Hamdan Al-Hazmi, MBBS, SBU, ABU, FPU (CANADA)
Consultant and head of pediatric urology, King Fahd medical city
Ali Moustafa Ali, MBBCH, MS, MD, MRCSEd

Assistant consultant pediatric surgery, King Fahd medical city
Turki Al HArbi, MD
Pediatric Emergency consultant, King Fahd medical city
Basem Turki Almussallam, MBBS

Resident general surgery, King Fahd medical city
4 of 4

03 Hair-Thread Tourniquet Syndrome in A Child Penis - Case Report and Review of Literature-1

Uploaded by

Copyright:

Available Formats

03 Hair-Thread Tourniquet Syndrome in A Child Penis - Case Report and Review of Literature-1

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

03 Hair-Thread Tourniquet Syndrome in A Child Penis - Case Report and Review of Literature-1

Uploaded by

Copyright:

Available Formats

ISPUB.

COM The Internet Journal of Urology

Hair-thread tourniquet syndrome in a child penis: Case

According to Saad et al; there were reviewed a total of 210

Hair remains the most common causative agent with a

Haddad, in his detailed review of penile strangulation, has

Our patient has nocturnal enuresis and he is 4 year and 6

Hair- thread tourniquet syndrome usually occurs in infants

CONCLUSIONS 2. Singh V et al. Acquired constriction ring syndrome as a

Ali Moustafa Ali, MBBCH, MS, MD, MRCSEd

Basem Turki Almussallam, MBBS

You might also like