Rita Justo Pereira1, João Tavares2, Maria João Virtuoso1
1Department of Pediatrics, Centro Hospitalar Universitário do Algarve, Faro, Portugal, 2Department of Pediatrics and Neonatology, Hospital Particular do Algarve, Faro, Portugal
Address for Correspondence: Rita Justo Pereira, Avª Calosute Gulbenkian Lote 46 MS, 5ºA, 8000-072 Faro, Portugal.
Email: anajustopereira@gmail.com
|
Question :A 9 year-old-boy was admitted to the pediatric emergency room with sudden genital pain and edema, which enables him to remove the bathing shorts. He is otherwise healthy, with no relevant past medical history. It was observed during the examination, the boy was uncircumcised and that the lateral portion of his penile foreskin was entrapped in the bathing shorts mesh lining causing a strangulation effect, leading to pain and edema (Figure 1). No injury of the penile shaft, urethra or scrotum was identified. The remaining physical exam was unremarkable.
The mesh liner was cut away for better visualization and handling of the affected area. Topical anesthesia with lidocaine-prilocaine (EMLA) and cryotherapy were applied enabling a further reduction of the entrapped tissue. Examination revealed a small laceration at the site of the constricted foreskin (Figure 2), with no lesion of the glans or urethral meatus. A normal urine steam was observed. He was discharged to home with the instruction to apply an antibiotic ointment to affected area for a few days.
Figure 1. Penile foreskin entrapped to the mesh lining of the bathing shorts. 
Figure 2. Small laceration at the site of the constricted foreskin.  What is the diagnosis?
|
Discussion :
Foreskin entrapment injury, although uncommon 1 with few reported cases in the literature, is a recognized non-iatrogenic penile injury mainly due to clothing. 1,2 The majority of cases occur in the pediatric age group. 2,3 Self-inflicted zipper lesions remain the most commonly reported penile injury in the pediatric population 4 as a result of the fast upward movement used when fastening the trousers.
The entrapped tissue may exhibit signs of bruising, lacerations, bleeding, edema or even a greater degree of tissue damage the longer the tissue is trapped. 5,6 For this reason, prompt attempt should be made to remove the entrapped tissue. However, multiple unsuccessful tries should not delay the search for medical care as the delayed presentation may worsen the treatment outcome. 5
It is known that a genital injury causes pain and acute distress in children. Therefore, administration of analgesia, topical anesthesia and non-pharmacological methods may be required to ensure successful management at the emergency department. 2
Most of the time the prognosis is good. 6 Nevertheless, to avoid this type of self-inflicted penile injury, it is recommended to remove the bathing suit mesh lining as a preventive measure prior to use. | References : | - Hoppa EC, Wiley JF. Bathing suit mesh entrapment: an unusual case of penile injury. Pediatr Emerg Care. 2006;22(12):813-814. doi:10.1097/01.pec.0000238745.81358.75
- Krishnan A, McCormick B, Swana H, et al. Acute Foreskin Strangulation Injury due to Bathing Suit Mesh Entrapment. Urol Case Rep. 2017;13:85-86. Published 2017 Apr 26. doi:10.1016/j.eucr.2016.05.009
- Mankowitz S. Laceration Management. J EMerg Med.2017; 53(3): 369-382.
- Wyatt JP, Scobie WG. The management of penile zip entrapment in children.Injury.1994;25 (1):59.doi:10.1016/0020-1383(94)90186-4
- Halis et al, Self-Inflicted Strangulation of Prepuce in a Child. APSP J Case Rep 2013;4:4
- Leslie SW, Sajjad H, Taylor RS. Penile Zipper and Ring Injuries. In: StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441886/
|
|
| Correct Answers : |  100% |
Last Shown : Oct 2025
|