Delayed presentation of penile strangulation by a foreign object: Case report with review of literature

Penile strangulation is a rare urological emergency first described in 1755, often resulting from foreign object entrapment leading to vascular compromise, oedema, and potentially necrosis or gangrene. It is associated with delayed presentation due to patient embarrassment and lacks standardized management protocols. This report emphasizes the clinical challenges and outcomes associated with delayed presentation and highlights a successful conservative management approach.

A 24-year-old unmarried South-Asian male with a history of cannabis use and abnormal behaviour presented with penile strangulation by a thick metallic ring of 96 h duration. Examination revealed Grade II penile injury with oedema and distal congestion. Initial decompression attempts failed. Penile block followed by aspiration of corpora cavernosa and use of feeding tubes alongside lubrication allowed successful removal via the string method. The patient developed a localized superficial infection managed with intravenous Piperacillin-Tazobactam following Escherichia coli growth in wound swab culture. He responded well and was discharged on postoperative day 7.

Penile strangulation requires individualized treatment based on severity. Minimally invasive techniques like aspiration and string method are effective for low-grade injuries. Literature supports emerging techniques involving non-traditional tools such as dental drills and air cutters, particularly in delayed or complex presentations. Complications like infection and necrosis are more common with delayed presentation, emphasizing the need for early intervention and public awareness.

Early recognition, appropriate technique selection, and multidisciplinary care are key to preventing long-term sequelae. This case reinforces the effectiveness of conservative decompression methods in low-grade injuries despite delayed presentation.