An unusual case of strangulation of penis by metal hammer head- (a case report)Sulabha V Punekar, PR Shroff, ML Vaze
Department of Surgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Bombay-400 012., India
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 731615
Source of Support: None, Conflict of Interest: None
An unusual case of metal hammer-head causing strangulation of penis and retention of urine is reported. The clinical presentation, detailed history and subsequent treatment is discussed. It also includes a review of the literature regarding such cases of strangulation of penis.
Series of cases of strangulation of penis due to metal ring, nut and bolt, rubber band, or hair are reported in the literature. Most of these are self inflicted in adult patients but in children they are introduced by other persons or ignorant mother.
M.B., a 40 year old male patient, mechanic by profession, was transferred from a peripheral hospital to K.E.M. Hospital with a history of incarceration of penis in a metal hammer head. The patient tried to masturbate through the hole in the metal hammer head on the previous night about 14 hours prior to admission in this hospital. The hammer head was stuck at the root of penis, which the patient could not remove. A general practitioner had tried to , cut the metal with ordinary saw but failed to cut ½" thick metal see [Figure 1] on page 59A. The patient had not passed urine since previous night.
Patient was married for the last 15, years with three issues, the eldest being 13 years old. He had no psychological problem in married life or otherwise any time before. His wife and children were out of station during this incidence.
Patient was well built and nourished and in a good general condition. On local examination, a 4 inches long metal hammer head was stuck around the penis at the root as shown in [Figure 1]
The part of the penis distal to metal head was grossly oedematous. The skin near the prepuce and mid shaft was dark in colour with impending gangrene. The urinary bladder was distended unto umbilicus. The metal head could not be moved down and was very painful.
After preparation patient was given general anaesthesia and parts were prepared. Multiple needle punctures were made in the oedematous tissue, and the oedema fluid was squeezed out by pressing with ether soaks. Liquid Paraffin was used as lubricant and the metal head could be slowly pushed down and removed. Foley's Catheter was kept for 48 hours. There was superficial loss of skin on the dorsal aspect of the prepuce see [Figure 2] on page 59A.
After 48 hours circumcision was done. He was treated with antibiotics and stilbesterol. He had normal erection in the post-operative period.
He was diagnosed as a sex anxiety by a psychiatrist.
Incarceration of penis by foreign material like metal ring, steel nut, etc. is
Another case was reported by Campbell . A 70 year old man came with purulant discharge from long redundent prepuce. On retracting the prepuce a rubber band was found to encircle and cut through full thickness of penis. The patient had admitted that he had placed this object around penis some two months previously in order to help maintain erection. The patient had developed urethral fistula.
In children, thread and hair have been reported as causes of strangulation. Harrow  has reported a case of strangulation by thread which was burried by healed skin and could be seen only on dorsal aspect of penis after separating skin edges. Long hair as a cause of strangulation has been reported in infants which was removed by simple unwinding.  In one case mother admitted to wrapping hair around the penis to control enuresis. Kerry et a1  recommended incision of such constricting hair or thread at inferolateral aspect between the corpus cavernosum and corpus spongiosum of penis to avoid injury to the main blood vessels and nerves.
One curious case of gangrene of penis caused by string tied around penis was described in literature.  This was not an instance of an alcoholic or an amorous trick but occurred in an orphan from an asylum. Such gangrene is invariably associated with string deep into the tissues and ultimately leading to urethral fistula. 
We thank Dr. C. K. Deshpande, Dean, K. E. M. Hospital for allowing us to publish the hospital data.
[Figure 1], [Figure 2]