Introduction: Strangulation of the genitalia by a metallic device is a rare occurrence. However, such cases present a challenge to any healthcare professional because of the difficulty associated with removing the device.Observation: Herein, we present the case of a patient with genital strangulation that was resolved quickly using a bolt cutter.Conclusion: Bolt cutters are useful for quickly removing metallic strangulation devices, even those made of thick metal

Abe, T.

Ochiai, H.

Sasaki, A.

English

AJOL - African Journals Online

African Journal of Urology (2018) 24, 383–386African  Journal  of  UrologyOfficial journal of the Pan African Urological Surgeon’s Associationweb page of the journalwww.ees.elsevier.com/afjuwww.sciencedirect.comGenito-urinary TraumaCase reportA  novel  technique  for  removing  a  metal  constric-tion  device  causing  genital  strangulation  using  abolt  cutter:  A  case  reportT.  Abe ∗,  A.  Sasaki 1,  H.  OchiaiDepartment  of  Trauma  and  Critical  Care  Medicine,  University  of  Miyazaki  Hospital,  Miyazaki,  JapanReceived 5 September 2018; received in revised form 18 October 2018; accepted 5 November 2018; Available online 6 December 2018KEYWORDSPenile strangulation;Scrotum strangulation;Metal constriction device;Bolt cutterAbstractIntroduction:  Strangulation of the genitalia by a metallic device is a rare occurrence. However, such casespresent a challenge to any healthcare professional because of the difficulty associated with removing thedevice.Observation:  Herein, we present the case of a patient with genital strangulation that was resolved quicklyusing a bolt cutter.Conclusion:  Bolt cutters are useful for quickly removing metallic strangulation devices, even those madeof thick metal.© 2018 Pan African Urological Surgeons Association. Production and hosting by Elsevier B.V. This is an openthe CCftmtrCaccess article under IntroductionGenital strangulations are relatively rare in the emergency room;however, they can be a challenging problem for any healthcare pro-∗ Corresponding author at: Department of Trauma and Critical CareMedicine, University of Miyazaki Hospital, 5200, Kihara, Kiyotake,Miyazaki, 889-1692, Japan.E-mail address: tomohiro abe@med.miyazaki-u.ac.jp (T. Abe).1 Present address: Department of Emergency Medicine, Kobe City Med-ical Center General Hospital, 2-2-1, Minatojima-Minamimachi, Chuo-ku,Kobe-city, Hyogo, 650-0047, Japan.Peer review under responsibility of Pan African Urological Surgeons’Association.AtH2cdhttps://doi.org/10.1016/j.afju.2018.11.0051110-5704/© 2018 Pan African Urological Surgeons Association. Production aBY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).essional, especially in strangulations caused by metal devices, ashey are difficult to remove. Motorized tools are often used to removeetal devices [1–7]. Herein, we report a case of genital strangula-ion caused by a thick metal constriction device, which was rapidlyesolved using a manual-powered bolt cutter, with no complications.ase  report man in his 30 s was admitted to the emergency department athe University of Miyazaki Hospital with penile and scrotum pain.e had no prior history of psychological problems. Approximately6 h prior to admission, he had placed a metal device around theircumference of his penis and scrotum to strengthen his erectionuring self-stimulation. On admission, he was struggling, and hisnd hosting by Elsevier B.V. This is an open access article under the CC384 Figure  1  The appearance of the patient’s penis and scrotum.The patient’s penis and scrotum were strangulated by the constric-tion device, resulting in severe congestion and swelling. Limited spaceexisted between the device and the skin.FTpsw5eArmdMcwdtc(ttqWeaDItapTnBfittcG[(duutwpcdIacswbBbasucbIplmcbomtctigure  2  The constriction device (after separation).he constriction device was a 5–10-mm thick metal ring made of steel.enis and scrotum were severely congested and swollen because oftrangulation by the metal constriction device (Fig. 1). The deviceas teardrop in shape, made of stainless steel, 10 mm in width, and–10 mm in thickness (Fig. 2). His urine was clear and there was novidence of hematuria.lthough we had initially planned to use a string technique, metaling cutter, or diamond dental drill to remove the metal device, theseethods may have taken considerable time because the constrictionevice was thick. Finally, we decided to use a bolt cutter (BC-0760,CC Corp®, Mie, Japan) that had been placed in the building safetyontrol center. After procedural intravenous sedation with propofol,e inserted the top of the cutting edge of the bolt cutter between theevice and the abdominal side of the skin. Nothing could be insertedo protect the skin due to the severe swelling. By pinching the boltutter slowly, we successfully made a crack in the band of the deviceFig. 3). Subsequently, we made a second crack in the other side ofhe device, resulting in the device separating into two pieces. OncemficT. Abe et al.he device was broken, the strangulation of his penis and scrotumuickly resolved. The removal took approximately three minutes.e confirmed that the skin was intact after the procedure. He did notxperience any pains or hematuria during the overnight observation,nd he was finally discharged on day 2.iscussionn this study, we present the case of a patient with genital strangula-ion caused by a thick metal device that was rapidly removed with bolt cutter. Constricting devices are used to prolong and increaseenis erectile function for sexual intercourse or self-stimulation.hese devices obstruct venous blood flow and lymphatic chan-els, resulting in penile congestion with enhanced penile erection.ecause the rate of high-grade penile injuries (such as urethralstulae, necrosis, and gangrene) is higher in cases with a time-o-admission exceeding 72 h compared to that in cases with aime-to-admission below 72 h [4], clinicians should remove theonstricting device as early as possible.enital strangulations by various metal devices have been reported1–10]. Motorized tools powered by electricity or compressed aire.g., a circulating saw or grinder [1–5], pedal cutter [6], or dentaliamond drill [7]) have been used to remove the metal devices,sually under general anesthesia [3,5,8,9]. In these methods, thenderlying skin is protected from the cutting edges using metallicongues or blades [1,2,4,5,6,11], which may be cooled by ice orater against the heat and sparks of the motorized tool to avoidrocedural skin complications [3,10]. However, protective bladesannot be inserted in cases involving limited space between theevice and skin due to severe swelling of the penis or scrotum.n such cases, penile aspiration with a hollow-bore needle [2,8]nd incision to the penis [9] may be necessary to reduce the penileongestion. In the present case, although the penis and scrotum wereeverely swollen, we did not perform these procedures because weere able to inset the top of the cutting edge of the bolt cutteretween the device and the skin.olt cutters are usually used for cutting metallic bars, such as ironars, in settings of building demolition, the destruction of padlocks,nd so on. To our knowledge, only two cases of penile and scrotumtrangulation caused by a metal constriction device were resolvedsing a manual-powered bolt cutter have been reported [5,10]. Onease was caused by a 30-mm wide and 5-mm thick stainless steelearing [5], the other case was caused by a radiator clamp [10].n the former case, the metallic device was completely cut in twolaces; the details of the removal procedure were not provided in theatter case report. The use of large orthopedic pin cutters to removeetal constriction devices has been reported [11]. In this patient’sase, the band on the constriction device was completely pinchedetween the broad edges of the bolt cutters, allowing the entire widthf the constriction device to be cut. Our technique, which involvedaking two cracks in the constriction device by pinching it with theop edge of the bolt cutters, is the first such description of metalliconstriction device removal. The bolt cutter is potentially equivalento the thin cutting-edge type of orthopedic pin cutter for removingetallic devices. Although the bolt cutter was not originally createdor use as a medical device, our technique may be useful for casesn which the bands of the constriction device are wide, and thinutting-edge type orthopedic pin cutters are not readily available.Bolt cutter for removing metal devices 385Figure  3  The bolt cutter and depiction of the procedure.een tho piecCWbafsAWfRThe top edge of the bolt cutter was inserted into the limited space betwwere made in the band, resulting in the separation of the device into twSkin injuries during a removal procedure using a bolt cutter havebeen reported [10]. The skin injuries may be caused by the tool orthe debris from the destroyed device. Therefore, if the degree ofswelling allows, something should be placed between the skin andthe device to protect the skin during the removal procedure, evenwhen using a bolt cutter.ConclusionThe bolt cutter is a useful choice for quickly removing metal foreignbodies, including thick metallic devices. However, caution shouldbe taken to prevent potential skin injuries.Conflict  of  interestAuthors declare no conflict of interests.Authors’  contributionsTakahiro Nagai M.D. was responsible for the evaluation and man-agement of the patient, conceptualization, reviewing the literature,and writing the manuscript; TA was responsible for the evalua-tion and management of the patient and identifying the relevantliterature; HO was responsible for editing and supervising the devel-opment of the article.Source  of  fundingAuthors declare no funding source.e device and the skin. By pinching the band of the device, two crackses.onsent  from  the  patiente could not obtain written informed consent from the patientecause we were unable to contact him after discharge. We removedll identifiable images and information, and we obtained approvalor this protocol from the Institutional Review Board at the Univer-ity of Miyazaki Hospital (2017-060).cknowledgmente would like to thank Takahiro Nagai M.D. for his cooperationor the patient care.eferences[1] Santucci RA, Deng D, Carney J. Removal of metal penileforeign body with a widely available emergency-medical-services-provided air-driven grinder. Urology 2004;63:17–8,http://dx.doi.org/10.1016/j.urology.2004.01.021.[2] Talib RA, Canguven O, Al Ansari A, Shamsodini A. Treatmentof penile strangulation by the rotating saw and 4-needle aspirationmethod: two case reports. Arch Ital Urol Androl 2014;86:138–9,http://dx.doi.org/10.4081/aiua.2014.2.138.[3] Kyei MY, Asante EK, Mensah JE, Klufio GO, Paintsil A, Gepi-AteeS, et al. Penile strangulation by self-placement of metallic nut. GhanaMed J 2015;49:57–9, http://dx.doi.org/10.4314/gmj.v49i1.10.[4] Silberstein J, Grabowski J, Lakin C, Goldstein I. Penile con-striction devices: case report, review of the literature, andrecommendations for extrication. J Sex Med 2008;5:1747–57,http://dx.doi.org/10.1111/j.1743-6109.2008.00848.x.[5] Perabo FGE, Steiner G, Albers P, Müller SC. Treatment of penilestrangulation caused by constricting devices. Urology 2002;59:137.3[http://dx.doi.org/10.1111/j.1553-2712.1999.tb00127.x.[11] Chennamsetty A, Wenzler D, Fischer M. Removal of a penile con-striction device with a large orthopedic pin cutter. Case Rep Urol2014;2014:347285, http://dx.doi.org/10.1155/2014/347285.86 [6] Sathesh-Kumar T, Hanna-Jumma S, De’Zoysa N, Saleemi A. Gen-italia strangulation—fireman to the rescue! Ann R Coll Surg Engl2009;91:4–5, http://dx.doi.org/10.1308/147870809X400976.[7] Etetafia MO, Nwajei CO. Successful removal of strangulating metalpenile ring using a dental handpiece. BMJ Case Rep 2014:3–5,http://dx.doi.org/10.1136/bcr-2014-205030.[8] Noh J, Kang TW, Heo T, Kwon DD, Park K, Ryu SB. Penile strangu-lation treated with the modified string method. Urology 2004;64:33–4,http://dx.doi.org/10.1016/j.urology.2004.04.058.[9] Vähäsarja VJ, Hellström PA, Serlo W, Kontturi MJ. Treatment ofpenile incarceration by the string method: 2 case reports. J Urol1993;149:372–3, http://dx.doi.org/10.1016/S0022-5347(17)36088-3.T. Abe et al.10] Brock S, Kuhn W. Removal of constricting bands usingthe Dremel drill. Acad Emerg Med 1999;6:1182–3,

A novel technique for removing a metal constriction device causing genital strangulation using a bolt cutter: A case report

https://www.ajol.info/index.php/aju/article/download/182289/171667

A novel technique for removing a metal constriction device causing genital strangulation using a bolt cutter: A case report

Abstract

Similar works

Full text

Available Versions

AJOL - African Journals Online