<p>Penile Injury During Ritual Circumcision</p>

Abstract

Purpose: Circumcision is one of the most prevalently performed surgeries worldwide. It is a common non-therapeutic procedure, which, based on the cultural and social background of people, could be performed by individuals at different levels of skill ranging from trained medical professionals to non-specialists. Therefore, this surgery could cause complications of varying frequencies and types. For example, penile damage during the circumcision procedure is a severe and rare complication leaving patients with morbidity and lifelong consequences. Here, we reported two cases of penile injury during a ritual circumcision. Patients and Methods: This study was approved by the ethics committee of Ibb University of Medical Sciences. Case 1: A 6-month-old child was brought to hospital by parents with complaints of purulent discharge around the penis after ritual circumcision performed 3 days ago with complete skin loss in the whole part of the penis extended to the scrotum and suprapubic area. Case 2: A 2-month-old child was brought to hospital with complaints of penile discharge and gangrene after ritual circumcision performed 10 days ago. Results: Case 1: He was treated with daily debridement and wound irrigation followed by a surgical procedure to bury the penis in the scrotum for future reconstructive surgery. Case 2: A suprapubic cystostomy was inserted into the bladder. Then, daily debridement and wound irrigation was performed for the child. To treat penile gangrene, two options were available. The first option was to bury the penis in the scrotum and do reconstructive surgery later. The second option was to change the child's anatomical sex from male to female. Conclusion: We suggest that every child, before a circumcision procedure, should be evaluated by a medically trained professional. This procedure should also be carried out in aseptic conditions. Additionally, the circumcision procedure needs to be performed by an experienced medical professional.

Catastrophic Complications of Circumcision by Traditional Circumcisers

“…This is particularly important in places, such as Yemen, where the bulk of circumcisions is made by non-qualified clinicians and the complications of the circumcision procedure are frequently unreported, and it is often impossible to follow up the patients. 4 , 8 …”

“…As natural genitalia is important for accomplishing a positive penile identification, in particular around puberty, performing penis reconstruction surgery during the childhood period is critical to minimize the emotional impact of this surgery. 4 …”

“…It is commonly a slight occurrence that does not necessitate reoperation. 4 A simple compressed dressing would suffice. In some cases, local administration of epinephrine and lidocaine is needed to obtain hemostasis.…”

“…Infrequently, if bleeding diathesis is not observed during the routine preoperative assessment, the patient may need a transfusion or intravenous administration of clotting factors. 4 , 13 …”

“… 3 The rate varies according to several factors, including medical comorbidities, type of surgical procedure, anesthesia use, non-professional practitioners, and age of the child. 4 Partial and/or total amputation of penis and death due to this procedure are exceedingly rare, so the report of these complications and outcomes of this procedure requires documentation. We describe two cases of catastrophic penile injury following ritual circumcision in this report.…”