Clinical Rounds

STEAMBOAT SPRINGS, COLO. – A big bottle of mineral oil is well worth keeping in the office if for no other reason than to help solve one of the most excruciatingly painful common problems in pediatrics: penile zipper entrapment.

Most textbooks advocate cutting the median bar of the zipper as the first-line solution. But that’s not the best method. A mineral oil drenching is the way to go, according to Dr. Steven M. Selbst, professor and vice chair of pediatrics at Jefferson Medical College, Philadelphia.

Dr. Steven M. Selbst

"I’ve done this many times. You want to just pour mineral oil all over the patient’s genitalia and the zipper. Be generous – that’s the key. This is pretty cheap stuff. Then let the patient sit there for 20 or 30 minutes. Pack him in a room somewhere. When you come back, the foreskin will have simply slipped out of that zipper, although in some cases you may need a cotton swab to help it along a bit," he explained at the meeting sponsored by the American Academy of Pediatrics.

Cutting the median bar of a zipper isn’t as easy as it might sound. A metal zipper is a sturdy apparatus.

"We used to call housekeeping stat to the emergency department – ‘and bring wire cutters,’ " Dr. Selbst recalled. "But I can tell you that when you go to the patient holding wire cutters, you’ll see his eyes bulging out."

The injured boy often presents with swelling, maceration, and bleeding as a result of the foreskin being caught in the zipper teeth. It’s often helpful as an initial step to cut away the pants from the zipper area to remove the extra weight dragging downward.

Some texts suggest doing a penile block. Dr. Selbst advised against it.

"Most kids would rather die with that zipper attached to them than have you do a penile block. Most of us aren’t all that comfortable doing them anyway," the pediatrician commented.

After the penis has been freed, it’s important to warn the parents about the risk of infection and the need to keep the area clean. Prophylactic antibiotics are worth considering, although there aren’t good data to support efficacy, Dr. Selbst said.

He reported having no financial conflicts.

02/17/12  

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EXPERT ANALYSIS FROM A MEETING ON PRACTICAL PEDIATRICS SPONSORED BY THE AMERICAN ACADEMY OF PEDIATRICS

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