Penile Strangulation Caused by a Seal Ring

Strangulation or incarceration of the penis due to a foreign body is a rare clinical scenario; however, it requires immediate and propermedicalmanagement.Theself-placementofawiderange of different daily-used devices generally responds to masturbatory or maintaining erection purposes (Dell’Atti, 2014). Asoccurs inordinaryparaphimosis, strangulationof thepenis produces a blockade of the venous and lymphatic return, thus generating distal edema and making the removal of the object more difficult. When this situation is maintained over time, the arterial circulation may be affected, which compromises the viability of the penile tissues, leading to necrosis of these structures (Kyei et al., 2015). We report a case of a44-year-old male, withoutpsychiatric disordersorotherrelevantmedicalhistory,whopresentedto the emergency department complaining of swelling and edema of the penis as well as significant pain for 2 days. On examination, we observed an important edema due to the strangulationcausedbyconstrictionof thepenile shaftdue to the placement of a seal ring (Fig. 1). He placed the ring on his penis 4 years ago to satisfy the desire of his sexual partner, but he did not report any similar episode previously. We tried to remove the ring after performing distal compression of the penile edema but not satisfactorily. Therefore, we decided to remove the ring in the operating room; we contacted theTraumatologyDepartment,whichadvisedusaboutthematerial needed toremove thering.Firstly, localanestheticwas infiltrated into thepenisand,with thehelpofapaletteknife, the ringwascut withsurgeryshears.Thesurgicalproceduretookabout1 h(Fig. 2). Finally, paraphimosis was reduced traditionally. Glans edema simulating paraphimosis can occur in many othersituations incircumcisedoruncircumcisedmenor inpenile entrapmentinjuries.Inthesecases,externalobjectsmayconstrict the mid to distal penis, leading to the same pathophysiologic disease seen with paraphimosis (Dubin & Davis, 2011; Massoud et al., 2010). These objects may be placed accidentally (e.g., hair tourniquetandzipper injuries)or intentionally, likemetal ringsor other constricting objects (e.g., glass bottles, plastic bottles, and piercings) (del Cano-Garcia, Santiago, Rosa-Martinez, Perales-