Glans Ischemia after Circumcision in a 16-Year-Old Boy: Full Recovery after Angiography with Local Spasmolysis, Systemic Vasodilatation, and Anticoagulation

Abstract

Circumcision is one of the most frequent procedures performed by pediatric surgeons. A dorsal penile nerve block (DPNB) is commonly used for perioperative analgesia. We report the case of a 16-year-old boy with ischemia of the glans who presented on the first postoperative day after circumcision under DPNB (0.25% bupivacaine) at an outside hospital. The patient underwent immediate angiography under sedation. An intra-arterial spasmolysis was performed with alprostadil and nitroglycerine and a sufficient perfusion of the glans penis was confirmed. Subsequently, systemic sildenafil, arginine, and heparin were given. Following this 3-day medical treatment, ischemia resolved completely. Our case emphasizes the role of invasive angiography in the diagnostic workup and the therapeutic possibilities of local spasmolysis, systemic vasodilatation, and anticoagulation.

Glans ischemia after circumcision in children: Two case reports

“…Notably, in a similar case, Efe et al [ 5 ] reported an elevated D-dimer level, with restoration to normal level after five days of enoxaparin treatment, suggesting a penile vascular thrombosis even though CDI showed normal penile and glandular blood flow. Conversely, both Karaguzel et al [ 4 ] and Gnatzy et al [ 6 ] reported their experiences, describing two cases of acute GI after circumcision with a normal level of D-dimer and good penile blood flow at CDI. Regarding our cases, the first one showed normal blood flow at CDI but D-dimer value was not checked.…”

“…Furthermore, Aminsharifi et al [ 11 ] reported the use of topical testosterone, which has been shown to improve the vascular density of foreskin in vitro , in two cases of delayed GI after circumcision, which resulted in complete healing after one month. Selective angiography with intra-arterial injection of a vasodilator agent has been reported by Gnatzy et al [ 6 ] in association with oral sildenafil and infusion of L-arginine hydrochloride and unfractionated heparin. Lastly, as previously reported, anticoagulant therapy using enoxaparin has been effective in case of GI after circumcision[ 5 ].…”

Writing a Case Report in Pediatric Surgery: A Comprehensive Guideline

“…Therefore, we strongly recommend the use of preoperative imaging studies, intraoperative pictures/videos, or images of histopathologic examinations. 8,[17][18][19] With smartphones readily available, photo and video documentation has been further facilitated. 20,21 Obtain written permission from the patient (if appropriate), parents, or caregiver to use medical information and images.…”

“…Many journals (e.g., European Journal of Pediatric Surgery Reports ) do not use the standard subheadings (i.e., Introduction, Methods, Results, and Discussion referred to as IMRaD) in the abstract. 8 9 However, other journals encourage IMRaD even in the abstract. Thus, consult the “Instructions for Authors” of the target journal before you write the abstract.…”

Glans Penis Ischemia after Circumcision in a 15-Year-Old Patient Managed with Intravenous Pentoxifylline: A Case Report and a Diagnostic-Therapeutic Guideline Proposal

“…The etiopathogenic mechanisms underlying this lesion are unknown, although it has been postulated that it may be related to preoperative anesthetic blockade (both in formulations with and without epinephrine), to the use of compressive penile bandages, and to the inadvertent damage of vascular structures during the procedure [1]. It has also been postulated that it may be in relation with a spasm of the dorsal artery of the penis, although the only documented case in which supraselective angiography was performed at diagnosis did not document vasospasm [2]. Briones/Bronte Anaut/Bardají Pascual…”