Post-injection necrotic phlegmon of the penis in a 13-year-old boy

Abstract

The practice of injecting various substances into the tissues of the penis in order to increase its size is found among adult men in different countries. An analysis of domestic and world literature revealed only one publication of a clinical case of treatment of a 16-year-old teenager with penile oleogranuloma. A 13-year-old boy was admitted to the pediatric surgical department with complaints of pain and severe swelling of the penis. According to the patient (found out later), these symptoms appeared 3 days after injecting 4 ml of Vaseline oil with a syringe under the skin of the penis. Swelling and hyperemia of the skin appeared, the next day the temperature rose to 40 °C, dizziness, nausea appeared, there were repeated vomiting and loose stools. The cause of the disease was established only after detailed questioning in the department. Local status: the penis is sharply increased in volume due to pronounced vitreous edema, mainly along the dorsal surface, the skin is hyperemic with dark areas and detachment of the epidermis. Diagnosis: “Necrotizing phlegmon of the penis, condition after injections of Vaseline oil”. After medical preparation, surgery was performed. Under endotracheal anesthesia, a 2 cm incision was made along the dorsal surface of the penis. A turbid liquid of 35–40 ml was released from the wound cavity, drainage was done with rubber drains. After the operation, antibacterial therapy and dressings with hydrophobic ointment were carried out. The general condition of the child returned to normal, the wound was cleaned, a defect measuring 5 × 3 × 0.2 cm was formed. After 2 weeks, plastic surgery was performed according to the Diettel method: the foreskin was cut to the area distal to the granulating wound, the outer and inner leaves of the foreskin were sharply separated, a graft was formed from the outer layer and fixed to the wound. The postoperative period was favorable, healing was by primary intention. The patient was discharged in satisfactory condition on the twenty-fourth day from hospitalization. When examined after 4 months, the patient has no complaints; on the dorsum of the penis there is a normotrophic scar measuring 2 × 3.5 cm, which does not interfere with skin mobility. The introduction of foreign bodies under the skin of the penis, accompanied by serious complications, began to be practiced among adolescents. Therefore, this case report will be of interest not only for pediatric surgeons and urologists, but also for doctors of other specialties who may be approached by patients with changes in the penile area, since a true history cannot always be ascertained.