Removal of a Penile Constriction Device with a Large Orthopedic Pin Cutter

Penile strangulation is an infrequent clinical condition that has widely been reported. It usually results following placement of a constriction device to enhance sexual stimulation. Early treatment is essential to avoid potential complications, including ischemic necrosis and autoamputation. We describe the use of a Large Orthopedic Pin Cutter to remove a metal penile constriction device in the Emergency Department (ED). This case report describes the relatively safe technique of using an instrument available in many hospitals that can be added to the physician’s arsenal in the removal of metal constriction devices. 1. Introduction Penile strangulation is a rare and challenging clinical presentation that usually requires urgent management. It generally follows self-placement of a constriction device for enhancing sexual stimulation or by persons suffering from psychiatric illness [1]. The condition has been widely reported in the literature with the first reported case in 1755 [2]. The choice of method for removal depends on the type and size of the metal object, incarceration time, trauma grade, and availability of equipment [3]. Early treatment is essential to avoid potential complications including ischemic necrosis, diminished sexual function, and even amputation [4, 5]. Removal of these objects often produces considerable anxiety in the patient as well as the physician and presents a great challenge to the latter. Ideally, one should employ a method that is noninvasive and quick. There have been various reports of removal of these devices using various saws, grinders, and other motorized tools, sometimes requiring assistance from professionals such as firemen, facility engineers, and jewelers [6–12]. We describe the use of a large orthopedic pin cutter, an instrument available in many hospitals, for the removal of a metal constriction device. 2. Case Report A 49-year-old man presented to the ED complaining of pain and swelling of his penis secondary to an incarcerated penile constriction device placed 9 days before presentation. The device was placed by the patient himself for autoerotic motive. He later found that he was unable to remove it. He had no history of psychiatric illness and did not seek any medical attention prior to the ED visit. He complained of increasing swelling and severe pain. He was able to urinate but had a decreased force of stream. Physical exam revealed a tightly encircling metallic ring with peripheral cogs placed on the midshaft of the penis causing severe penile engorgement and edema (Figure 1). The metal appeared to be