Penile strangulation by a metallic nut in an 8-year-old male: A rare case report of urological emergency

INTRODUCTION AND IMPORTANCE: Penile strangulation due to metallic objects in pediatric age groups is a rare urological emergency that warrant emergency management. Removal of metallic ring from strangulated penis poses a great challenge to urologist as it may require industrial gadgets. Multidisciplinary management involving psychiatrist is required. To the best of our knowledge, this is the first reported novel case of penile strangulation by a metallic nut in children in Tanzania. Furthermore, this case report shows that Industrial Manual Scissor metal (IMSMC) cutter offers a safe way of removing metallic nut from strangulated penis with few complications. CASE PRESENTATION: We report a case report of penile strangulation in an 8 year-old boy by a metallic nut which stayed for 11 h prior to arriving at a tertiary hospital in Northern Tanzania. The reason for insertion of nut by a child was not clear. CLINICAL DISCUSSION: On arrival to the hospital the child was clinically stable but in pain. Local examination revealed a metallic nut at proximal penis with grossly edematous penis. A diagnosis of penile strangulation by metallic nut was reached and the child was planned for emergency surgery to remove the metallic nut. The metallic nut was successful removed by IMSMC. This technique has been used in adult with success with few complications and therefore opted in our setting. The child was also diagnosed with oppositional defiant disorder. CONCLUSION: Industrial Manual Scissor Metal cutter is a safe way of managing penile strangulation by a metallic nut in children.