Abstract

Background: There are complications and bleeding differences among obese and buried penis cases. Bleeding symptoms in these cases may not indicate the amount of bleeding. Continuation of bleeding without symptoms may bring along other problems such as trapped penis. Objective: Aim of the study is to draw attention to hematoma and associated trapped penis cases, to explain the mechanism of trapped penis formation through established theories based on the fluid mechanics, to demonstrate that minor hemorrhages, which occur in patients with the buried penis, may be incompatible with the amount of bleeding.
Materials & methods: Patients with penile/perineal hematoma that developed after routine ritual circumcision, which was performed under local anesthesia in healthy individuals, were included in the study group, and their clinical characteristics were examined. Clinical and hematological conditions were noted down. It was planned to establish a bleeding model based on the topographic structure of the buried penis and under principles of fluid mechanics.
Results: Seven patients who developed penile/perineal hematoma and associated trapped penis complications after 901 circumcision procedures were included in the study. It was determined that the bleeding stopped in an average of 3.42 hours, and the trapped penis condition started in an average of 3.41 hours. It was found that the trapped penis and skin discoloration disappeared completely in an average of 5.00 and 8.14 days respectively. The model was established according to the principles of fluid mechanics by evaluating the bleeding, which occurred due to the change of position upon the telescopic movement during the circumcision procedure of the buried penis cases in the fat pad.
Discussion: In the literature, trapped penis cases have been discussed, but edema, regional hematoma, and temporary trapped penis formation have not been addressed. The main limitation of our study is that tissue viscosity and coagulation properties are not addressed under the principles of fluid mechanics, there is no other study by which we can evaluate the pathology, the number of cases in our study is limited.
Conclusion: Positioning of the buried penis could reveal different bleeding characteristics, and trapped penis may develop. Telescopic movement of the penis could be considered as a reason for the hematoma to occur in the subcutaneous and perineal areas. In patients with the hidden penis, the amount of bleeding may not be noticed in the first hours since the area where the bleeding pools are hidden.

Keywords:Circumcision; Trapped penis; Mechanism; Hematoma; Bleeding