Acute glans ischemia after circumcision successfully treated with low-molecular-weight heparin and topical dihydrotestosterone: A case report. Issue 29 (17th July 2020)

• Record Type: Journal Article
• Authors: Zvizdic, Zlatan; Anic, Dusko; Popovic, Nusret; Vranic, Semir
• Other Names: Saranathan. Maya section editor.
• Is Part Of: Medicine. Volume 99:Issue 29(2020)
• Publication Date: 2020-07-17
• Subjects: circumcision -- complications -- glans ischemia -- treatment; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000021340
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Circumcision like any other surgical procedure is not devoid of complications. Serious complications are rare and include iatrogenic hypospadias, glans ischemia/necrosis, and glans amputation, all of which require an emergent treatment. Patient concerns: We report here a case of 6 months-old-boy with a superficial glans ischemia following circumcision. Diagnosis: Physical examination revealed a severely cyanotic glans with the moderate edema of the dorsal penile skin. Plasma levels of D-dimer were 8.57 mg/L. Urine passage was unremarkable while color Doppler ultrasonography revealed a normal blood flow. Interventions: The patient was successfully treated with subcutaneous injection of enoxaparin (low-molecular-weight heparin) and topical 2.5% dihydrotestosterone. Outcomes: The appearance of the glans penis on the 5th day was close to normal while the control levels of D-dimer dropped to the reference range. The patient was discharged from the hospital on the 6th day. At 6-month follow-up, the appearance of the glans penis was normal. Lessons: Acute glans penis ischemia following circumcision is a rare complication. Its successful treatment with enoxaparin and topical dihydrotestosterone has not been previously reported in the literature.