An elderly dementia patient strangled his own penis after wrapping rubber bands around it and leaving them on for three days.
The unidentified 81-year-old had to have emergency surgery in Chicago, Illinois, after the skin on the tip of his member started to rot.
Yellow and purple patches began to appear on the shaft and base of his penis too because of the lack of blood supply.
Experts said the patient’s penis could have fallen off if doctors hadn’t removed the bands when they did.
The African-American man, whose grisly case was published in a medical journal, was originally admitted to hospital due to complications from his diabetes.
His wife turned medics’ attention to the rubber bands, which she said her husband had refused to remove for between two to three days.
Doctors at the University of Chicago Medical Centre operated to prevent further degradation.
Dead tissue was removed using a hot wire and scalpels and antibacterial lotions were applied as he recovered over five days.
A catheter — a tube put through the urethra — was used to drain the urine that had built up in his bladder as he’d been unable to urinate.
An 81-year-old man with dementia strangled his own penis to death with rubber bands in Chicago, Illinois
He recovered well from the surgery but failed to return for a check-up appointment two-weeks after leaving the hospital.
The patient had originally went to hospital after suffering diabetic ketoacidosis — a potentially deadly reaction to low levels of insulin.
When doctors asked him about the rubber bands, the man appeared to be confused.
WHAT IS PENILE STRANGULATION?
Penile strangulation is a rare but often dangerous medical emergency that occurs when an object or body part blocks the blood supply to the penis.
In the worst cases, the lack of blood flow can result in gangrene and the death of tissue — penile necrosis.
Medics have devised a grading system to indicate the severity of strangulation:
Grade 1: Edema of distal penis.
Grade 2: Injury to skin and constriction of corpus spongiosum, but no evidence of urethral injury. Distal penile edema with decreased penile sensation.
Grade 3: Injury to skin and urethra but no urethral fistula. Loss of distal penile sensations.
Grade 4: complete division of corpus spongiosum leading to urethral fistula and constriction of corpora cavernosa, with loss of distal penile sensations.
Grade 5: gangrene, necrosis, or complete amputation of the distal penis.
Early surgical intervention is required once
His penis was severely swollen and the tip had begun to change in colour and shape. The skin was breaking down and had become gangrenous.
The authors of a case report published in Urology Case Report said the man’s diabetes made the damage done by the rubber bands worse.
The bands caused ischemic damage — damage caused by restricted blood flow — which was compounded by already circulation flow from his diabetes.
They said: ‘The patient in our case presented with diabetic ketoacidosis and a likely history of uncontrolled diabetes.
‘The ischemic damage from strangulation compounded with poor blood flow to the ischemic tissue from the underlying diabetic vascular disease can lead to a progression to a necrotic or gangrenous state.
‘In this case, the best management is early surgical intervention and debridement which can slow the progression of disease and reduce morbidity.’
Dr Fardod O’Kelly, urological surgeon at Beacon Hospital in Dublin, told MailOnline the man’s penis could have fallen off if the bands had been left on for too long.
He said: ‘Strangulation cases like this are thankfully rare. The veins and lymphatics become very easily compressed due to an increase in local pressure. This leads to severe pain and swelling.
‘An organ like the penis could probably tolerate this for a couple of hours (if you don’t pass out with the pain), however eventually the pressure becomes too great and the arteries become compressed as well.
‘This is important as the arterial compression means no blood flow in, and that means no oxygen supply, so the organ begins to die.
‘In theory, if you left it long enough the penis could fall off, but I’ve never seen that happen.’
Penile strangulation is a rare but dangerous emergency in boys and men of all ages, often linked to sexual acts and occasionally mental illness.
It occurs when an object or hair cuts the blood flow off from the penis, resulting in swelling and, in the worst cases, necrosis and gangrene.
Medics have determined a five point scale to describe the level of damage caused by strangulation.
It ranges from low levels of swelling to tissue death and the complete loss of the end of a penis.
In this case, the man was on the lowest end of the scale at first, before his symptoms worsened to level three: Injury to skin and urethra but no urethral fistula — an abnormal connection between the urethra and bladder — and loss of sensation.
The authors warn that medics should review patients’ medical backgrounds to check whether early intervention is required to prevent symptoms worsening up the scale.
Vascular and blood-flow conditions can worsen the effects of strangulation, requiring early surgery to salvage the organ.