by Benjamin P. Harrison, MD, CPT, MC
Staff Physician, Department of Emergency Medicine, Emergency Medicine Residency Program, Darnall Army Community Hospital, Fort Hood, Texas (BPH)
Chief complaint:
Painful penile swelling and inability to void for 6 hours.
History of present illness:
A 3 year old uncircumcised male is brought to the ED by his mother complaining of gradually worsening pain, redness, and swelling of his penis. The symptoms began one day prior but have worsened throughout the day. The child has not been able to void over the previous six hours before presentation "because it hurts." The mother denies any history of previous symptoms. There are no recent complaints of fever, chills, frequency, hematuria, or changes in behavior or appetite. The child is "toilettrained" and has never had voiding difficulties in the past. The mother bathes the child daily but admits that she rarely pulls back his foreskin while cleaning his penis. The child's past medical, past surgical and birth histories are unremarkable. His immunizations are current and he is taking no medications. He has no known drug allergies.
Physical examination:
The patient is a nontoxic appearing white male who looks anxiously about as he intermittently sobs in his mother's arms. Vital signs are normal for his age. The physical exam is normal except for the genitourinary system.
The patient's distal foreskin covering the glans is tender, warm and erythematous with localized edema (figure 1). The foreskin cannot be retracted and a small amount of purulent discharge can be expressed from the significantly constricted preputial orifice. No apparent trauma is visualized around the penis, scrotum, or perineum. There is no apparent scrotal tenderness or mass, and his testicles are bilaterally descended.
Laboratory:
No laboratory studies are obtained.
The patient course, diagnosis and discussion will be published in Academic Emergency Medicine 3(4):April 1996.
You can also get the result here on EMBBS next month.
Disclaimer: This article represents the views of the author and is not to be interpreted as official, or representing the United States Army or Department of Defense.
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