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Urosepsis and postrenal acute renal failure in a neonate following circumcision with Plastibell device.

Kalyanaraman M, McQueen D, Sykes J, Phatak T, Malik F, Raghava PS - Korean J Pediatr (2015)

Bottom Line: Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine.Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention.Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Critical Care Medicine, Children's Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ, USA.

ABSTRACT
Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates.

No MeSH data available.


Related in: MedlinePlus

Photograph of the Plastibell circumcision device, in two different sizes.
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Figure 1: Photograph of the Plastibell circumcision device, in two different sizes.

Mentions: Plastibell device is widely used in neonates and infants as it is easy to use and circumcision can be safely performed even by trained nurses and in developing countries with low complication rates. Plastibell device is a clear plastic ring with a deep groove running circumferentially designed for circumcising male neonates. The Plastibell is placed onto the head of the penis during a short surgical procedure. This procedure can be performed by an experienced physician using adequate anesthesia and appropriate size Plastibell device (Fig. 1). The device functions with the principle of severing blood supply to part of foreskin tissue which dies and sloughs off by itself about 3-7 days after circumcision. The major advantage with its use lies in the quickness of the procedure, and easy monitoring of the child. However, acute renal failure has been reported after circumcision in neonates and infants who had ritual or surgical excision of the foreskin1,2). We report for the first time to our knowledge a case of fulminant urosepsis and postrenal acute renal failure in a neonate after circumcision using Plastibell.


Urosepsis and postrenal acute renal failure in a neonate following circumcision with Plastibell device.

Kalyanaraman M, McQueen D, Sykes J, Phatak T, Malik F, Raghava PS - Korean J Pediatr (2015)

Photograph of the Plastibell circumcision device, in two different sizes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4414631&req=5

Figure 1: Photograph of the Plastibell circumcision device, in two different sizes.
Mentions: Plastibell device is widely used in neonates and infants as it is easy to use and circumcision can be safely performed even by trained nurses and in developing countries with low complication rates. Plastibell device is a clear plastic ring with a deep groove running circumferentially designed for circumcising male neonates. The Plastibell is placed onto the head of the penis during a short surgical procedure. This procedure can be performed by an experienced physician using adequate anesthesia and appropriate size Plastibell device (Fig. 1). The device functions with the principle of severing blood supply to part of foreskin tissue which dies and sloughs off by itself about 3-7 days after circumcision. The major advantage with its use lies in the quickness of the procedure, and easy monitoring of the child. However, acute renal failure has been reported after circumcision in neonates and infants who had ritual or surgical excision of the foreskin1,2). We report for the first time to our knowledge a case of fulminant urosepsis and postrenal acute renal failure in a neonate after circumcision using Plastibell.

Bottom Line: Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine.Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention.Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Critical Care Medicine, Children's Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ, USA.

ABSTRACT
Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates.

No MeSH data available.


Related in: MedlinePlus