Total penile amputation following ritual circumcision: A case report of a devastating complication

Abstract

Circumcision is among the most commonly performed surgical procedures in boys. In Morocco, this practice is often carried out by traditional practitioners, exposing patients to potentially catastrophic complications that are challenging to manage. We report the case of a 2-year-old boy who underwent ritual circumcision complicated by total penile amputation, with loss of the amputated stump. A meatoplasty was performed, and the postoperative course was uneventful. This case underscores the importance of recognizing circumcision as a surgical procedure that should not be trivialized. Furthermore, it highlights the necessity of implementing training programs for traditional practitioners to promote safe circumcision practices.

Highlights

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Circumcision is extremely common worldwide and often performed for cultural, religious, or nontherapeutic reasons.
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Proper medical supervision is critical to avoid severe complications during the procedure.
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Potential complications can be catastrophic , ranging from minor incidents to severe injuries, including partial or total penile amputation.
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Penile amputation after circumcision is a severe emergency with complex management and serious functional and psychological effects.

1 Introduction

Circumcision is one of the most widely performed surgical procedures worldwide, practiced for religious, cultural, and medical reasons. It is often regarded as a simple, safe operation when performed by trained medical professionals. However, the procedure is not devoid of risks, particularly when conducted under non-sterile conditions or by untrained practitioners. Complications can range from minor incidents to severe injuries, including partial or total penile amputation.

Although rare, penile amputations following circumcision constitute a significant medical emergency due to their profound impact on both functional and psychological health. Managing such cases remains challenging, even for experienced urologists. We present a case of total penile amputation that occurred during circumcision and was treated with meatoplasty.

2 Case presentation

We report the case of a 2-year-old boy who was admitted to our Pediatric Surgery department for management of a complete penile amputation. The injury occurred during a circumcision procedure performed by a traditional practitioner at the child’s home three days prior to presentation. The circumcision was performed by grasping the foreskin between the fingertips and retracting it over the glans towards the distal end of the penis. The traditional practitioner excised the foreskin distal to the glans using scissors, followed by cauterization to control hemorrhage. The amputated stump was not preserved, and the practitioner reassured the parents that the amputated portion would regenerate. However, the parents’ concern prompted them to seek medical consultation at our hospital. On admission, the child was hemodynamically stable. Physical examination revealed a complete amputation of the penis with a hematoma covering the section slice. No active bleeding was noted. Following a complete blood count, which demonstrated a normal hemoglobin level, the patient was transferred to the operating room.

Under general anesthesia, surgical exploration revealed a complete transection located at the proximal 1/3 of the penile shaft approximately 2 cm from the penoscrotal junction, with sectioning of the corporal bodies and the bulbar urethra ( Fig. 1 ). There was no amputated stump available for replantation. Firstly urethral catheterization was done using a 8-Fr Foley catheter which was introduced through the meatus of the distal amputated penile segment and then the urethra of the proximal amputated penile stump into the urinary bladder which was verified by the presence of urine in the catheter. Then, a meatoplasty was performed in three planes via 4/0 Vicryl sutures in separate stitches: spongio-urethral suture on a charriere 8 urethral catheter, suture of the albuginea of the corpora cavernosa; suture of the skin and subcutaneous tissues was done via Vicryl sutures 4/0 ( Fig. 2 ). Following surgery, the patient received a 7-day course of intravenous amoxicillin/clavulanic acid, and was discharged with the catheter for prevention of urethral stenosis. The urinary catheter was removed 21 days post-surgery with the patient voiding with the good urinary stream ( Fig. 3 ).