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

Richard Gnatzy; Jochen Fuchs; Manuela Siekmeyer; Anne Bettina Beeskow; Jan-Hendrik Gosemann; Martin Lacher

doi:10.1055/s-0038-1667330

European Journal of Pediatric Surgery Reports, Inhaltsverzeichnis

CC BY 4.0 · European J Pediatr Surg Rep. 2018; 06(01): e66-e69
DOI: 10.1055/s-0038-1667330

Case Report

Georg Thieme Verlag KG Stuttgart · New York

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

Richard Gnatzy

¹Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany

,

Jochen Fuchs

²Department of Diagnostic and Interventional Radiology, 310 Klinik GmbH, Nuremberg, Germany

,

Manuela Siekmeyer

³Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany

,

Anne Bettina Beeskow

⁴Department of Radiology, University of Leipzig, Leipzig, Germany

,

Jan-Hendrik Gosemann

¹Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany

,

Martin Lacher

¹Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany

› Institutsangaben

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.

Keywords

Glans Ischemia - children - digital subtraction angiography

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Referenzen

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