Tourniquet syndrome?accident or abuse?

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Abstract
The tourniquet syndrome describes severe strangulations of appendages by hair, cotton or similar material mainly observed in young infants. The painful swellings of digits or external genitals are surgical emergencies because the strangulation can cause ischaemia and tissue necrosis. More than 100 cases of the tourniquet syndrome have been reported in most of which the aetiology was unclear. We have treated five patients with a tourniquet syndrome. Four of them presented with strangulations of one or more toes by hair or threads and one girl was diagnosed with a clitoral tourniquet syndrome. In each case the strangulating material could be removed in time avoiding permanent damage. The lack of any reasonable explanation and the meticulous wrapping made a non-accidental course very likely. Due to the lack of convincing explanations in our cases as well as in most of those described in the literature, we suggest that the tourniquet syndrome is often the result of child abuse, an aetiology overlooked for decades. Conclusion:the tourniquet syndrome in childhood should be included in the list of possible forms of child abuse and should be considered as a differential diagnosis until another aetiology can be convincingly proven.

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