Diphallia with associated congenital malformations

BACKGROUND: Diphallia is an extremely rare congenital pathology in which children are born with a double penis. Diphallia is usually accompanied by systemic abnormalities, and their degree varies from no associated abnormalities to multiple abnormalities, including genitourinary, gastrointestinal, and musculoskeletal ones. Mortality among infants born with diphallia is higher due to infectious diseases accompanying developmental anomalies.

CLINICAL CASE DESCRIPTION: The presented case is an example of diphallia with associated developmental malformations and the staged surgical treatment which resulted in good outcomes.

DISCUSSION: Diphallia is treated surgically, but in each case, it is necessary to take into account the concomitant pathology. The main cause of death in children with diphallia are concomitant severe developmental defects, so the treatment is carried out in stages. In this case, because of the anorectal defect, intestinal obstruction was eliminated first by forming a sigmoid colostomy. Subsequently, after the child’s condition improved and he developed further, a staged surgical treatment was performed: removal of a lipoma in the cauda equina, simultaneous surgery (removal of the penis, elimination of the rectovesical fistula, lowering the rectum and forming the anus, elimination of vesicoureteral reflux, plastic surgery of the anterior abdominal wall), osteotomy with reduction of the right femur head and fixation with an L-shaped plate. The next stage of surgical treatment is the correction of the curvature of the spine and pelvic bones.

CONCLUSION: In case of diphallia associated with other pathologies of organs and systems, especially of anorectal malformations, the initial formation of a double-barreled sigmostostomy helps to stabilize the child’s condition and to postpone radical surgery to the time more convenient for the patient and the doctor.