- Case Report
- Open Access
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.
- Foreign Body
- Sexual Performance
- Male Genitalia
- External Genitalia
- Metal Ring
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.
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.
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