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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
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
,
Jochen Fuchs
2   Department of Diagnostic and Interventional Radiology, 310 Klinik GmbH, Nuremberg, Germany
,
Manuela Siekmeyer
3   Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
,
Anne Bettina Beeskow
4   Department of Radiology, University of Leipzig, Leipzig, Germany
,
Jan-Hendrik Gosemann
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
,
Martin Lacher
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
› Author Affiliations
Further Information

Publication History

10 June 2018

23 June 2018

Publication Date:
28 September 2018 (online)

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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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