Rupture of the Corpus Cavernosum in a Pediatric Patient

Pediatric penile pain is an uncommon complaint and is associated with a wide differential diagnosis including infectious, inflammatory, traumatic, and idiopathic conditions. Penile fractures, anatomically known as rupture of the corpus cavernosum, are almost exclusively reported in sexually mature patients and usually involve forceful manipulation during sexual activity. Rupture of the corpus cavernosum is a true urologic emergency. Failure to recognize and treat rupture of the corpus cavernosum has been associated with residual penile angulation, persistent hematoma, abscess, erectile dysfunction, and fibrosis. We present the case of a previously healthy 7-year-old boy who presented to our emergency department with complaints of penile pain with movement after falling and colliding with staircase railing. Examination showed ecchymosis and swelling of the penile shaft; both testicles were palpable and nontender, with no perineal or scrotal bruising. Ultrasound noted discontinuity along the right corpus cavernosum consistent with a rupture of the right corpus cavernosum. Testicles were noted to be in the scrotum with normal Doppler flow. Flexible cystoscopy revealed an uninjured urethra and bladder. Our patient was urgently taken to the operating room for repair of his injury. Thanks to the timely surgical correction, there were no postsurgical complications, and he was discharged home on postoperative day 1. This case demonstrates that although most reports of corpus cavernosum injuries are associated with sexual intercourse, other modes are possible and should be considered for acute-onset penile pain in pediatric patients.