A case of penile gangrene

doi:10.4236/crcm.2013.28117

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Vol.2, No.8, 448-449 (2013) Case Reports in Clinical Medicine

http://dx.doi.org/10.4236/crcm.2013.28117

A case of penile gangrene

Bobby Desai*, Irina Brennan, Brandon Allen

Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, USA;

*Corresponding Author: [email protected]

Received 28 August 2013; revised 30 September 2013; accepted 20 October 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Penile gangrene is a rare entity and is usually

associated with significant trauma. We report on

a self-inflicted cause of penile gangrene in a pa-

tient who sought enhancement.

Keywords: Penis; Gangrene; Enhancement

1. INTRODUCTION

Penile modification is done for many reasons,

including peer pressure, enhancement of penile girth and

length, and for a perceived increase in female pleasure

[1]. There can be significant complications of modifica-

tion, from the urethral injury, to penile abscesses. Late

complications of modifications include chronic pain and

erectile dysfunction [2]. Penile modification is becoming

more commonplace in the United States [2].

2. CASE

A 55-year-old man with no significant past medical

history presented to the emergency department with the

waiting room triage complaint of priapism. He reported

progressive worsening of penile pain and swelling for

three weeks after an attempt at male enhancement at

home. The patient had no difficulty with urination and

denied fevers or chills. His review of systems was non-

contributory. On physical examination, his vital signs

were normal, with no fever. His cardiac, respiratory,

abdominal and neurologic exam was normal. On physi-

cal examination of his inguinal and genital area, a foul-

smelling, poikilothermic, edematous and insensate penis

along the entire corpus and glans was revealed (Figure

1), along with a weight inserted over the penis (Figure

2).

Urology was consulted to see the patient. The patient

underwent immediate penile exploration and operative

foreign body removal. The initial procedure was

followed by tissue removal to the Buck’s fascia with

bilateral corpora cavernosa reconstruction and skin

Figure 1. Patient’s genital region on presentation to the emer-

gency department demonstrated priapism and necrosis.

Figure 2. Patient’s genitalia with the encompassing 7.5l b free

weight attached to his waist with a combination of strings and

wire.

grafting of the glans and penile shaft. The patient’s

psychiatric evaluation was significant for poor insight

and mild developmental delay.

3. DISCUSSION

Penile gangrene is secondary to incarceration by a

B. Desai et al. / Case Reports in Clinical Medicine 2 (2013) 448-449 449

foreign object. The patient placed 7.5l b free weight

around the base of his penis for “penile enlargement”

(see Figure 2) but was subsequently unable to remove

it secondary to edema. Penile strangulation was first

reported in 1755. Accounts in medical literature have

placed around the penis since described various metallic

and nonmetallic objects, mostly for autoerotic or per-

formance enhancement purposes. The time from incar-

ceration to require medical attention can range from

hours to weeks and directly correlates with hospital stay

[3,4]. Complications vary from mild vascular obstruction,

urethral strictures and fistulas to severe gangrene, septic

shock and death [5]. The treatment priority is detu-

mescence to facilitate blood flow and urination. Penile

amputation may be necessary in cases of severe injury

[6].

REFERENCES

[1] Thomson, N., et al. (2008) Penile modification in young

Thai men: Risk environments, procedures and widespread

implications for HIV and sexually transmitted infections.

Sexually Transmi tted Infecti ons, 84, 195-197.

http://dx.doi.org/10.1136/sti.2007.028530

[2] Nguyen, D.P., Bobby, K.D. and Michael, F. (2011) Visual

Diagnosis: Pearling: a case study. International Journal

of Emergency Medicine, 8, 1-3.

[3] Detweiler, M. (2001) Penile incarceration with metal

objects: A review of procedure choice based on penile

trauma grade. Scandinavian Journal of Urology and Ne-

phrology, 35, 212-217.

http://dx.doi.org/10.1080/003655901750291980

[4] Xu, T., Gu, M. and Wang, H. (2009) Emergency man-

agement of penile strangulation: A case report and review

of the Chinese literature. Emergency Medicine Journal,

26, 73-74. http://dx.doi.org/10.1136/emj.2008.062877

[5] Morentin, B., Biritxinaga, B. and Crespo, L. (2011)

Penile strangulation: Report of a fatal case. The American

Journal of Forensic Medicine and Pathology, 32, 344-

346. http://dx.doi.org/10.1097/PAF.0b013e3181d8e3a5

[6] Bart, S., Culty, T., Pizzoferrato, A.C., Thibault, F., Girault,

N., Chartier-Kastler, E. and Richard, F. (2008) Complete

necrosis of the penis and testes by strangulation in a psy-

chotic patient. Progrès en Urologie, 18, 483-485.

http://dx.doi.org/10.1016/j.purol.2008.04.014