Acute glans ischemia after circumcision successfully treated with low-molecular-weight heparin and topical dihydrotestosterone

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.

Other Information

Published in: Medicine
License: http://creativecommons.org/licenses/by/4.0
See article on publisher's website: https://dx.doi.org/10.1097/md.0000000000021340