林祖鋒1,2、楊迪媛1,2、林文榮1,2

1馬偕紀念醫院泌尿科,2馬偕醫學院

A rare case of hex ring spanner cause paraphimosis
Tsu-Feng Lin1,2, Ti-Yuan Yang1,2, Wun-Rong Lin1,2

1Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan

2Department of Medicine, Mackay Medical College, Taipei, Taiwan

 
Introduction: 
Paraphimosis occurs when a tight foreskin ring is retracted over the glans penis for a prolonged period. The tight ring constricts the distal penis causing vascular occlusion, and cannot be replaced in its normal position. We present a rare case of paraphimosis resulted from a hex wrench.
 
Case:
A 66-year-old man presented with progressive penile swelling, pain and voiding difficult for 3 days. He had a history of type 2 diabetes and erectile dysfunction for many years. He made a bet with his friend that he can put his penis into the ring of a hex ring spanner. However, due to the penis became swelling progressively, he cannot remove the ring spanner. On physical examination, the following conditions were noted: the penis stuck in the ring of spanner; the inside diameter of the ring was about 2 cm; skin erosion; foreskin swelling, redness and tenderness. Firefighters tried to use bolt cutter and grinder to remove that but failed due to too hard to cut and the ring stuck at penoscrotal junction resulting no enough space to use those tools properly. We consult the dentist, they used dental drill and grind the ring piece by piece. When drilling the ring of the spanner, we used a thin metal plate to protect penile tissue. Continued normal saline irrigation was given to lower the temperature. After remove the ring, the symptoms of pain improved a lot and the patient can void smoothly. Debridement was performed for partial foreskin necrosis 5 days later and the wound was closed with local flap 10 days later without further complication. 
To our knowledge, this is the first reported case of using dental drill to remove a metal foreign body from an entrapped penis in emergency department. Dental drill is a safe and effective tool that is easy to get in the hospital. In clinical practice of facing paraphimosis resulted from metal foreign body, dental drill is an appropriate option.