Stitch granuloma of the penis: A very rare complication after male circumcision

摘要

Surgical suture material is usually inert and nontoxic and causes minimal inflammation of tissue. It is not ordinarily a source of infection. Silk granuloma has been reported as benign complication seen after surgery elsewhere in the body. Suture granuloma can occur many months or years after the primary surgical procedure. The most common suture causing tissue irritation and subsequent granuloma is probably the silk (nonabsorbable suture) especially braided one. We report a granulomatous inflammatory tumour of penis in a fit two-year-old child. The lesion increased in size spontaneously within six weeks after circumcision.The child had symptoms of wound infection (i.e., pain, erythema, induration, and local tenderness with occasional seropurulent discharge) after closure of the circumcision wound with Vicryl suture material. Case report A 2-year-old male child presented with a slowly growing occasionally painful swelling on the penis of six weeks duration. Interestingly,patient had undergone right herniotomy and circumcision (for religious reasons) two months back. On physical examination, the patient appeared to be in good overall health. The child had symptoms of local wound infection (i.e., occasional pain, erythema, induration, and local tenderness with occasional seropurulent discharge). Examination revealed a 0.8x1cm firm, tender swelling on the right lateral shaft of penis. The overlying skin was discoloured, indurated and the lesion was free from the underlying tissue. There was no inguinal adenopathy. Laboratory examinations were within normal limits except for mild leucocytosis and increased sedimentation rate (20 mm/hour). A diagnosis of stitch granuloma penis was made. Excision of the lesion was performed under anesthesia. The granuloma was excised in toto. There was no cosmetic or functional deficit postoperatively and full unrestricted erection was possible (by manual stimulation). Histopathology revealed a thinly encapsulated granuloma,consisting of mainly chronic inflammatory cells and some necrosis with no evidence of malignancy. At 5 months follow-up, there was no recurrence and the patient continues to live normally.