(P93) Complex Removal of a Penile Foreign Body

53 year old male presented to the ED for evaluation penile swelling and pain after patient put a steel hook on the shaft of his penis for approximately 48 hours. The patient was unable to remove the steel hook after 48 hours and noticed severe pain and swelling to the penis that had moved to the patients testicles. The patient attempted to remove the hook at home unsuccessfully. The patient reported increased pain and pressure around his shaft and testicles which prompted him to come into the ED for further evaluation and removal. Upon presentation, the patient was noted to be in severe, painful distress and 6mg of IV morphine was administered with slight reduction in penile pain. In light of the patient presenting with a steel foreign body to the penile area, the patient was administered tDAP for tetanus prophylaxis. Prior to removal attempt, a pudendal nerve block with 5 mL of Lidocaine without epinephrine was administered. A steel/diamond cutter saw was used on the steel ring with the support of steel pliers placed between the ring and the patients penis. The saw that was used ended up being fragmented and broken due to the strength of the steel ring and we had to replace the saw with a new blade/saw. Upon a second attempt, after a second pudendal nerve block, the second saw ended up breaking as well. After the failed second attempt, attempts were made to reduce the swelling of the shaft and testicles via direct compression along with ice water that the patient soaked his penis in for about 15-30 minutes. After another unsuccessful attempt to reduce the swelling enough to remove the object, a third pudendal block was administered along with additional dosing of IV morphine. Ultimately, after 3-4 hours, 2 broken saw's and 3 pudendal nerve blocks, the object was able to be removed safely with an orthopedic cast saw. There was initial fear of a penile fracture as the patients skin began to break down and the swelling increased to the point where the penis began to bend severely. The patient was seen by Urology and was noted to have no penile fractures or dead tissue and was inpatient for an additional 48 hours to monitor swelling and pain control. The patient was subsequently discharged home with no further complications.