Penile strangulation by metallic key holder in an adolescent: a case report and literature review

Penile strangulation is an uncommon urological emergency in which an external constricting object initially impedes venous and lymphatic outflow and, if prolonged, leads to arterial insufficiency and tissue necrosis.

A 16-year-old male presented after approximately 2 weeks of progressive penile swelling and pain following self-application of a metallic key holder at the midshaft. Examination revealed marked distal edema, coronal congestion, shaft erythema, focal ulceration, and areas of skin necrosis, with preserved distal sensation and no urinary retention. Clinical assessment suggested adequate distal perfusion without deep structural compromise. Under general anesthesia, the constrictor was divided and removed, necrotic tissue was debrided, a drain was placed, and prophylactic antibiotics were administered. At the 2-week follow-up, the wound had healed without infection; voiding and erectile function were preserved, and a psychiatric referral was arranged.

Injury severity is shaped by the duration of constriction, the device used, and the degree of preserved perfusion. Stepwise management from bedside techniques to operative or high-power cutting tools guides safe removal. Early decompression typically maintains urinary and sexual function, whereas delayed intervention increases the risk of stricture, erectile dysfunction, and gangrene. Coordinated surgical management and psychiatric follow-up are essential to optimize outcomes and reduce recurrence.

Penile strangulation demands urgent, device-specific intervention guided by assessment of constriction duration, perfusion status, and object composition. Adherence to graded management algorithms and early psychiatric evaluation are recommended to minimize long-term morbidity and address contributory behavioral factors.