Penile and scrotal strangulation caused by a steel ring: a case report
© Efthimiou et al; licensee BioMed Central Ltd. 2008
Received: 28 June 2008
Accepted: 18 July 2008
Published: 18 July 2008
Application of constricting devices on the external male genitalia for increasing sexual performance is an unusual practice that can potentially lead to penile strangulation with severe consequences. In this case report we describe a case of a 48 year old male who presented in our hospital with a steel ring on his external genitalia which led to penile strangulation and a short review of the literature. The foreign body was successfully removed by an angle grinder which was not immediately available in the operating theatre. The patient had an uneventful recovery.
Entrapment of metal rings that strangulate the shaft of the penis is a rare emergency in urology. Removal of these may be challenging for the Urologist . If the condition is left untreated there are potentially dangerous consequences for the patient. In this case report we describe a case report of a 48 year old male who presented in our hospital with a steel ring on his external genitalia which led to penile strangulation and was removed by an angle grinder which was not immediately available in the operating theatre with a short review of the literature.
Case presentation and discussion
A great variety of metallic and non-metallic rings causing constriction the external genitalia has been described in literature . The type of the foreign body differs in relation to age. In newborns and children penile strangulation with air or elastic rings has been described. The insertion of these rings may be accidental or intentional from the patient, a sibling or the parent [2, 3]. In adults various objects like wedding rings, metal plumbing cuffs, bull rings, bottle necks etc have been used . In adolescents it is usually the result of curiosity or masturbation while in adults the reason is to enhance sexual pleasure, autoerotism or as a result of a psychiatric disorder.
Insertion of constricting rings in the flaccid or semi erect penis may result to inability in removing them after erection. The object has been placed a few hours up to 3–4 days before seeking medical help and the patients have usually attempted unsuccessfully to remove the object themselves [1, 4].
In children the strangulation may be easily overlooked as an erosion or eczema. A high level of suspicion is required from the clinician to avoid missing it.
Within a few hours of obstruction of the blood supply, as stagnation of blood becomes more prominent, oedema and haemorrhage occur, causing a swelling of the affected part. Metallic rings usually cause less injury than non-metallic rings . Delayed removal may lead to necrosis, fistula, sepsis and penile amputation .
Various procedures depending on the constricting object have been described for removal. These include the common metal ring cutter, cutting tang, metal saw, Dremel Moto-Tool Kit, Anspach cement eater, high speed drill, string method, and "wrapping" by package cord .
Usually removal is accomplished under general anaesthesia. The urologist must remove the ring with great care to avoid iatrogenic injury to the external genitalia. It should also be kept in mind that removal of these objects may be challenging and require equipment that is not directly available in the urology department.
Strangulating foreign bodies of male external genitalia may require resourcefulness in order to be removed safely with no consequences for the patient. General anesthesia may be necessary to facilitate extraction.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Perabo F, Gabriel S, Albers P, Muller S: Treatment of Penile strangulation caused by constricting devices. Urology. 2002, 59 (1): 137-139. 10.1016/S0090-4295(01)01485-6.View ArticlePubMedGoogle Scholar
- Dar NR, Siddiqui S, Qayyum R, Ghafoort T: Hair coil strangulation-an uncommon cause of penile oedema. Pediatr Dermatol. 2007, 24 (4): E33-35. 10.1111/j.1525-1470.2007.00436.x.View ArticlePubMedGoogle Scholar
- Clem JG: Penile strangulation by externally applied foreign bodies. Urol Cutan Rev. 1929, 33: 175.Google Scholar
- Ivanovski O, Stankov O, et al: Penile strangulation: Two case reports and review of the Literature. J Sex Med. 2007, 4 (6): 1775-1780. 10.1111/j.1743-6109.2007.00601.x.View ArticlePubMedGoogle Scholar
- Bhat AL, Kumar A, Mathur SC, Gangwal KC: Penile strangulation. Br J Urol. 1991, 68: 618-621.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.