67 y/o male presents to a local Emergency Department with penis swelling. On exam of the mans genitalia a metal ring was found at the base of the penis. Per the patient he had consumed a fair amount of alcohol and was feeling somewhat frisky. The gentleman felt that it was in his best interest to extend his erection. Not having a standard device the patient looked over and saw what he described as a metal washer. He placed it on is penis and wiggled to the base. The patient apparently felt some discomfort and attempt to remove the “item”. Unfortunately he was unable to do so. The patient though that as his erection dissipated that he would have a better chance in removing it. Unfortunately the “item” was so tight that it impeded venous return causing additional swelling. After “3 or 4” days of attempting to remove the item by use of various lubricants and a iron file, the patient was unsuccessful in removing the “item”. By the time the patient came to the hospital his penis was approximately three times the normal size with edema, reddened, and tissue breakdown had begun at the penis base. The nurse and physician attempted to use a manual ring cutter with no results. The metal was quite thick. Bolt cutters were them attempted, however there was an insufficient amount of the device for the bolt cutter to grab a hold of. After much deliberation, and a couple of calls tot he hospital maintenance staff, the emergency team obtained a “Dremel Tool” and fitted it with a fiberglass reinforced cutting wheel. A thin piece of x-ray plastic was placed between the penis and the metal washer. The penis was wrapped with wet gauze and self adhering bandage (CoBan) to protect the rest of the penis. As the physician began cutting a large amount of sparks began to fly from the metal, two RN’s used normal saline flushes to douse the penis and pubic hair to prevent burning. The metal washer was cut along the left and right lateral sides, and was removed without injury to the patient. The patient was observed for approximately one hour and subsequently sent home, with orders for follow up and skin care.
The moral of this story is not for the patient, it is for the Emergency Room physicians and nurses. This next fiscal quarter place a request for a Dremel Tool. It is a handy tool, and when you least expect it, you will need one! Oh yes one more thing....turn off the oxygen prior to releasing sparks into the room! (That’s a whole other story!)
