Thrombotic cutaneous gangrene with autoamputation of the penis: a rare extracolonic manifestation of ulcerative colitis in a child

[Thrombotic skin gangrene: A rare extra-intestinal manifestation of ulcerative colitis]

BACKGROUND

Thrombotic cutaneous gangrene is a rare extra-intestinal manifestation of ulcerative colitis with a severe prognosis.

CASE REPORT

A 35-year-old woman with a 7-year history of ulcerative colitis presented with extensive ecchymotic lesions that began a few hours earlier. On examination, she was febrile with multiple necrotic lesions. Skin biopsy showed multiple microthrombi in the dermal vessels. A diagnosis of thrombotic cutaneous gangrene was established. The patient was treated with heparin and systemic corticosteroids. The majority of cutaneous lesions showed improvement after 1 month. Thrombophlebitis of the left lower limb occurred subsequently.

CONCLUSION

Thrombotic cutaneous gangrene is attributed to microvascular thrombosis, which arises from the hypercoagulability observed in ulcerative colitis. Complete blood and coagulation tests must be performed and early anticoagulation with heparin must be considered in order to prevent the progression of cutaneous infarction.

Urinary incontinence following transurethral prostatectomy presenting as self inflicted penile gangrene

An elderly diabetic man with a 67 g prostate developed a moderate degree of stress urinary incontinence along with urge urinary incontinence after transurethral resection of the prostate. Initially, he did not perform the recommended pelvic floor exercise and wrapped a rubber band around his penis to control the problem. He presented with late development of penile gangrene requiring partial amputation of his penis. The stress urinary incontinence subsided on subsequent follow-up. The patient is now doing well.

Auto amputation of penis due to advanced penile carcinoma

A middle-aged man presented with progressively enlarging ulcer on the tip of penis over a year's duration and sloughing of whole penis subsequently. Examination revealed complete loss of penis and purulent discharge at its base. Biopsy of the base of the penis confirmed penile carcinoma. Imaging studies revealed extensive metastatic lesions. Palliative care was given, but he succumbed later. In this era of advanced medical care, symptoms of penile cancer are still being ignored and have led to autoamputation of penis.