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Unusual presentation of foreskin injury: accidental entrapment in bathing shorts mesh lining

Rita Justo Pereira¹, João Tavares², Maria João Virtuoso^1
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
Keywords : Entrapment, Foreskin, Penile, Mesh
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?