Abstract
We present a rare case of recurrent idiopathic ischemic priapism in a healthy 14-year-old male with no identifiable risk factors such as hematologic disorders, trauma, or medication use. The patient required surgical intervention after failing conservative measures, including aspiration and intracavernosal phenylephrine. A bilateral T-shunt ultimately achieved successful detumescence. Postoperative rehabilitation with tadalafil and a vacuum erection device preserved erectile function. This case highlights the importance of early recognition and a stepwise approach to pediatric priapism. It also raises the possibility of a novel association between chronic constipation and impaired venous outflow contributing to priapism in children.