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Management of priapism in a child with sickle cell anemia; successful outcome using epidural analgesia

[Prise en charge du priapisme chez un enfant souffrant d’anémie falciforme ; résultat favorable avec l’analgésie péridurale]

Paul McHardy, MD^*, Conor McDonnell, MD^*, Armando J. Lorenzo, MD, Joao L. Pippi Salle, MD PhD and Fiona A. Campbell, MD^*

^* From the Departments of Anesthesia, and
Urology, Hospital for Sick Children, Toronto, Ontario, Canada.

Address correspondence to: Dr. Fiona Campbell, Department of Anesthesia, The Hospital for Sick Children, 555 University Avenue, Room 2303, Toronto, Ontario M5G 1X8, Canada. Phone: 416-813-7445; Fax: 416-813-7543; E-mail: fiona.campbell{at}sickkids.ca

Purpose: To describe the successful management of priapism secondary to sickle cell anemia in a child using neuraxial analgesia provided via an epidural catheter.

Clinical features: A seven-year-old male presented with chest crisis and priapism which, following hemoglobin electrophoresis led to a new diagnosis of sickle cell anemia. Epidural management was attempted as an alternative to surgery after failure of more conventional medical and surgical methods to treat the priapism. The patient’s clinical condition improved with this intervention and together with further conservative therapy resulted in complete resolution of the priapism.

Conclusions: Priapism is a well described complication of sickle cell anemia that is painful and difficult to manage. Surgical intervention is the last therapeutic resort and often results in significant long-term morbidity. This case highlights how select cases of priapism can be successfully managed with epidural neuraxial blockade which not only provides superior analgesia for the often painful conservative treatments, but may also per se impart a direct and salutary therapeutic benefit.