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Tuesday, April 15, 2014

Penile incarceration by a metal ring


Guys, this should be obvious, but apparently isn't (or not to everybody, at any rate): placing a ring on your penis, and thus obstructing blood flow through this important organ, is NOT a good idea. An incarcerated penis is no fun... One unlucky Irishman learned this lesson the hard way.

A couple of years ago, a man presented to the emergency department of a hospital in Dublin, Ireland with severe penile pain and swelling. The patient, while under the influence of alcohol (he had consumed a whopping 72 or so units of booze over the preceding 3 days) had placed an industrial standard metal ring on his penis approximately five hours before presentation to enhance sexual pleasure. His penis was now grossly swollen and purple. 

Closer inspection revealed that the ring mechanism consisted of two rings of differing diameters. The external ring moved in a circular manner over the internal ring. A ridge was present on the inner, broader ring, preventing removal of the outer ring. The tip of the penis appeared bluish-black from the lack of circulation, but penile pulsation was present and sensation was intact. Attempts to manually decompress the penis and remove the constricting ring were unsuccessful, and the patient refused all forms of sedation (perhaps he feared that doctors might decide to amputate his penis while he slept?)

 


An incarcerated penis, swollen and purple, with the constricting metal ring visible near the base. A ring cutter is placed between the skin and ring. Image from: Fanning 2011


To remove the ring, doctors had to use some heavy-duty equipment: a stainless steel large ring cutter, a hand held rotary saw and pliers. Believe it or not, local fire services assisted in the procedure (highly amused, no doubt). Throughout the removal process, the penis was sprayed with cold water to prevent thermal burns from the mechanical stress of cutting and sawing. An expander tool, requiring substantial strength, was then used to remove the ring. The procedure took approximately 90 minutes to complete. Luckily, apart from some abrasions near the base, the guy's penis emerged unscathed, and there were no long-term complications. 

And the ER staff and firemen now have an interesting story to tell.


Source: 
Fanning DM (2011) Penile incarceration secondary to a penile ring device. BMJ Case Rep. pii: bcr0520114174. doi: 10.1136/bcr.05.2011.4174.


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