Successful Removal of a Penile Constriction Ring in a 14-Year-Old Male

Abstract

Penile strangulation is a rarely described medical emergency, especially in the adolescent population. This case demonstrates the successful removal of a constricting metal ring from the penis of a 14-year-old male with a diamond blade equipped orthopedic oscillating saw while under ketamine anesthesia in the emergency department.

Successful removal of a penoscrotal constricting ring in a 49-year-old male

“…In the literature, a few methods have been described for the removal of constricting metal devices, taking into account the severity of penile injury and the availability of tools. With metal rings that cannot be removed with conventional ring cutters, circular saw attachment (which is usually used for total joint arthroplasty), Gigli saw, pedal cutter [2] and power-driven cutting tools including dremmel saws [3] , and orthopaedic oscillating saws [4] have been employed previously.…”

“…Hence in our case, we had to be resourceful and expediently removed the constricting ring to avoid potential complications of ischaemic necrosis and auto-amputation. However, if the penis were to be gangrenous, or necrotic, or when other modalities have failed, de-gloving, or amputation of the penis may be indicated depending on the extent of devitalized tissue [4] .…”

Successful removal of strangulating metal penile ring using a dental handpiece

“…Numerous methods have been described for the removal of constricting devices. When choosing a method, the material to be removed, severity of penile injury and availability of tools2 should be considered to avoid further injury to the penis. Therefore, the prompt and safe removal of the strangulating agent by whichever instrument available is recommended.…”

“…Moreover, there is a challenge before the urologist to relieve the penis of the strangulation as quickly as possible to prevent it from becoming gangrenous. Penile rings have been removed successfully by adopting varying methods and tools including: string method,1 orthopaedic saw,2 stainless steel large ring cutter,3 angle grinder,4 surgery and, recently, the tuck technique 5. Although dental drills have been used to remove entrapped finger rings,6 7 the use of a dental handpiece as an emergency tool to relieve the penis of strangulation is rare, with only one case8 documented.…”

Successful Removal of a 3.6-cm Long Metal Band Used as a Penile Constriction Ring

“…Adequate tools for these procedures are very important and must allow on the one hand the removal of the object and on the other hand not to injure the patient and/or the surgical crew. Tools therefore used as reported in the literature are: bolt cutters, end cutting pliers, pipe tongs, drills, and metal saws including circular or oscillating saws [4,6,9–11].…”