Strangulation of the penis by a metal ring: An uncommon accident in a child

Strangulation of the penis by a metal ring is not common in pediatric urology.1 However, it is practiced by adults in order to increase their sexual pleasure: auto-erotic stimulation. Few people with psychiatric trouble can also happen to put a metallic ring on their penis.2 Strangulation result in the reduction of distal blood flow, edema, ischemia and even in gangrene when the appropriate care is not taken urgently.1 This is a case report about a 10-year- old boy with a strangulated penis for 48 hours and we describe the method of treatment. Observation A 10-year-old boy in third grade was admitted to the Lome-Commune Regional Hospital Center (RHC) for penis basis strangulation for 48 hours. The child put a ring at the basis of his penis out of curiosity and the parents have realized it only 48 hours later. They tried to remove it at home but could not. The child is the elder of three healthy siblings. He has never been hospitalized and carried no physical defects. At admission, the temperature was 37° 5C, the blood pressure: 110/70 mm Hg, pulse rate: 98/minute. The conjunctives were well coloured and not icteric. The child was fully conscious, with a Glasgow scale at 15 and a eupnoea breathing. A ring of about 3 cm in diameter strangulated the basis of the penis with a large edema. Fortunately, the skin is still alive, but less sensitive due to edema (Fig. 1). There was no retention of urine. The other apparatus were normal. We used 10 cc syringe to perform puncture-aspiration of the glans under general anesthesia in order to reduce the edema. Lubrication of the ring was then performed using red povidone iodine. The extraction was done by progressive decompressions on the distal part (Fig. 2, Fig. 3). Postoperatively, the patient was treated with clavulanic acid and amoxicillin at 500 mg twice daily and morniflumate suppository 400 mg twice daily. Due to a lack of financial means, the Doppler echo of the penile vessels which should help to assess the state of the penile vascularization was not realized. He was referred to a clinical psychologist who, after his examination, recognize that it was an isolated act. Open in a separate window Fig. 1 Metallic ring at the basis of the penis.