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    Penile Zipper Entrapment in a 47-year-old Male :

A Case Report

 

            Benjamin C. Deveza, M.D.

 

 

Department of Surgery

Ospital ng Maynila Medical Center

 

 

 

 

 

 

 

 

 

 

Reprint request : Benjamin C. Deveza, M.D.

Department of Surgery, Ospital ng Maynila Medical Center

ommcsurgery@yahoogroups.com

 

 

 

ABSTRACT

            A male Filipino patient was seen at the Emergency Room of a government hospital and presented with a zipper that got stuck in the shaft of the penis.  Patient claimed that he was unaware that the zipper was there. Upon consult at the Emergency room, a portion of the zipper was seen at the ventral aspect  of the penis. There was discharge noted at the site of the entrapment. Attempts were made to manually remove the zipper but was unsuccessful. Removal was done by excising a portion of the skin where the zipper was entrapped. Patient was discharged improved with take home medications and was advised with regards to penile zipper entrapment.

 The purpose of this report is to create awareness among health professionals and the public of the potential danger of penile zipper entrapment or “zipper bite”. Discussion focused on the consequences of such injury, how to avoid such a situation  and what to do when faced with the problem.

INTRODUCTION

The variety of possible penile traumas is indeed astonishing. These can be breakage of frenulum, incised or stab wounds of penis, penis bruise, hypodermic breakage of carvenous body, penis dislocation, penis entrapment, injuries of scrotum, inverted testis and others. Penile traumas usually occur in foreskin, glans, carvenous body and can be combined with scrotum infures. Some of these injuries are minor ones, but others affect sexual health dramatically.

One of the most frequent types of minor penile injuries is skin entrapment with a zipper or the so-called “zipper bite”.Though the wound usually is a small one, it is rather painful. Entrapment of penile foreskin is quite a distressing situation and can be a frustrating management problem. Any overzealous intervention would simply worsen the situation. Also, attempts to cut open the zip fastener are time taking and may not be either helpful or feasible in any situations. The approach to the zipper manipulation should be quick, simple, non-traumatic and reproducible irrespective of the age of the patient, mechanism and site of entrapment, presence of the local edema and zipper size or design.

Case Report

            This is a case of a 47-year-old male, married from the City of Manila who was seen at the Emergency Room of Ospital ng Sampaloc. Few days prior to consult, patient noted that a zipper got stuck in the skin of his penis. He tried to remove it but was unable to do so. He cut a portion of the zipper, leaving a part that was attached to the skin. At the Emergency Room, physical examination was done and showed a part of the zipper entrapped in the ventral aspect of the penile shaft. Purulent discharge was noted at the site of entrapment.

                                                                                                      

 

                                                                      

 

 

            Attempts were made to manually remove the zipper but failed. Removal was done by excising a part of the skin where the zipper was attached under local anesthesia.

        

 

            Patient was discharged improved with take home medications and advice.

 Discussion

Entrapment of unprotected penis into zipper is the most common cause of penile injury. In cases like this, various management strategies are reported, including an aggressive approach of partial excision of the entrapped foreskin, or a circumcision under general anesthesia. The non aggressive management strategies involve some form of mechanical disengagement of the zipper from the skin. One of the crude methods is to push the zip fastener in the opposite direction from which it had originally trapped the skin.  However, tugging at the zipper in either directions may result in a tighter entrapment or a further bruising as it tends to re-enact the original trauma in the reverse. Another technique described is to unfasten the zipper one tooth at a time, alternating sides. Also reported is giving transverse cuts through the cloth strips holding the tooth line, and allowing disengagement from both sides of the entrapment. Still others report use of mineral oil followed by traction. However, the most common method described so far, involves the division of the median bar connecting the anterior and posterior faceplates of the zip fastener, using a bone cutter or a mini hacksaw. These strategies of zip manipulation, while effective, are not very rapid and cause sufficient movement of the zipper and the penis and therefore, often require local anesthesia. Moreover, if the median bar lies deep or a portion of the entrapped prepuce projects ahead of the zip fastener, it may be very difficult and potentially dangerous to divide the median bar using these methods.

 

Prior to these procedures, adequate analgesia and/or sedation should be given. Liberal application of topical anaesthetic cream may work or local infiltration may be necessary (never use local agents with adrenaline on the penis).

If trapped between teeth below the slider:

  1. Cutting the median bar of the zipper with wire cutters. The median bar is the part at the top of the slider which joins the front and back plates of the slider. Once cut, the slider falls off and the zipper can be separated Cutting through the material either side of the zipper below the entrapped skin and then cutting across the zipper with wire cutters / strong scissors. Then the zipper can then be separated from below

If trapped between slider and teeth of zipper:

  1. Liberal application of topical anaesthetic cream, then ease slider down. 
    Always check for injury to urethral meatus.

Local wound care is advised. Patient is given appropriate antibiotics. Prevention of such injury include careful manipulation of the zipper in the pants  and wearing an underwear to avoid close and direct contact to the penis or scrotum.

 

 

 

References :

1.      Safe and Painless Manipulation of Penile Zipper Entrapment. Satish Chandra Mishra.From the Department of Surgery, NDMC Charak Palika Hospital, Moti Bagh I, New Delhi 110021,India.www.eMed.com

2.      Penile Injuries. www.eMed.com

3.      Penile Zipper Injury.Tatsuo Nakagawaa, Allan G. Toguri
Department of Urology, Nagano Matsushiro General Hospital, Nagano City, Nagano, Japan;
Department of Urology, The Scarborough Hospital, Toronto, Canada.www.eMed.com

4.      Clinical Practice Guidelines, The Penis and Foreskin. Royal Chhildren’s Hospital Melbourne. www.eMed.com

5.      Unsual Penile Problems and Injuries. www.eMed.com

 

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