A Case Report of Large Bowel Obstruction in a Patient With an Inflatable Penile Prosthesis

• Main Authors: Elias Atri, MD, Chase Mallory, BHS, Alejandra Perez, MD, Vivian Wong, MD, Billy H. Cordon, MD
• Format: Article
• Language: English
• Published: Elsevier 2021-08-01
• Series: Sexual Medicine
• Subjects: Inflatable Penile Prosthesis; Reservoir; Five-Step Technique; Adenocarcinoma; Bowel Obstruction; Large Bowel Obstruction
• Online Access: http://www.sciencedirect.com/science/article/pii/S2050116121000714

Introduction: Inflatable penile prostheses (IPP) consist of 2 cylinders implanted into the corpora cavernosa, a pump placed in the scrotum, and a saline-filled reservoir traditionally placed in the space of Retzius. IPPs are used to treat refractory erectile dysfunction with few rare, but serious, complications. Cases of reservoirs causing erosion into the bladder, small bowel obstructions, vascular compression, and inguinal herniation have been described. Aim: We highlight the importance of keeping a broad differential diagnosis when assessing patients with bowel obstructions. Methods: A 68-year-old man with a previous IPP placement presented with left lower quadrant abdominal pain, constipation and obstipation for 5 days. On exam, he was afebrile, and noted to have a firm, distended, tympanic abdomen. CT scan showed a distended cecum at 11 cm, narrowing of the proximal sigmoid with adjacent inflammatory changes, and minimal peri-colonic air, suggestive of a localized perforation. The IPP reservoir was seen in the left iliac fossa, coinciding with the lead point of the obstruction, suggesting that the reservoir may have itself caused the obstruction. The patient was taken to the operating room for an emergent exploratory laparotomy, which revealed a mass in the colon abutting the IPP reservoir. Main Outcome Measures: Considerations for IPP component explantation, factors considered for reintervention, and preservation of penile length with avoidance of penile fibrosis. Results: A left colectomy with transverse colostomy was successfully performed and the IPP reservoir was explanted. Intraoperative frozen section revealed adenocarcinoma. Upon initial review of the imaging, it was thought that the IPP reservoir may have caused the obstruction, but intraoperatively, the colonic tumor was found to be the culprit. Conclusion: Although complications related to IPPs, including bowel obstructions, have been previously described in the literature, treatment for large bowel obstructions must take into account all possible etiologies, including malignancy.Atri E, Mallory C, Perez A, et al. A Case Report of Large Bowel Obstruction in a Patient With an Inflatable Penile Prosthesis. Sex Med 2021;9:100391.