Gangrene and Partial Auto-Amputation of the Penis in a Case of Priapism

Abstract

Background: Penile Gangrene is rare, usually associated with extensive pelvic trauma, mechanical constriction, infection due to urinary extravasation and uncontrollable systemic infection. The objective of this case report is to stress upon the need for early detumescence by means of aspiration of accumulated blood, injection of phenylephrine, proper shunting of blood and adequate compression dressing with necessary antibiotic cover. Case Presentation: We present a case of 33-year-old married man who was hospitalized under general surgery department for left AK amputation because of lower limb gangrene. On 3rd postop day, patient was noted to have a turgid penis and unable to urinate. Urology consultation was sought after 3 days for suspected priapism. We immediately shifted the patient to OT and the detumescence of penis was achieved by means of aspiration and injection of phenylephrine followed by Winter’s shunting. The penis was noted to be flaccid with normal hue and patient was discharged. After 1 month, he returned to the hospital with extensive gangrene of the entire distal half of the penis with features of auto amputation of distal portion of penis. Conclusions: This report is aimed to prevent ischaemic complications of priapism like penile gangrene. Various factors like time of intervention, urethral catheter, tight pressure bandage dressing around the penis and local infection alone or in combination, have been implicated in causing penile gangrene in cases of priapism. Penile detumescence should be achieved on an emergency basis to prevent its ischaemic complications.

Keywords

• penile gangrene
• detumescence of penis
• winter’s shunt