title: Successful treatment with enoxaparin of glans ischemia due to local anesthesia after circumcision.
abstract: The severe ischemia or necrosis of the glans penis is a rarely seen complication after circumcision. We report the case of a 7-year-old boy with severe glans penis ischemia occurring 24 hours after circumcision with local anesthesia (0.1% xylocaine containing ephedrine). His hemogram and levels of proteins C and S and fibrinogen were normal, but the D-dimer level was higher than normal (2.57 mg/L; normal level 0-0.5 mg/L). Normal blood flow was indicated on color Doppler ultrasonography. The severe ischemia in the glans penis was successfully treated with subcutaneous injection of enoxaparin (low-molecular-weight heparin) for 5 days, and the appearance of the glans was close to normal on the fifth day. The patient did not require any surgical intervention and was discharged without sequelae. As a result, we consider that ischemia of the glans penis may initially be managed with enoxaparin, especially in cases in which the D-dimer level is higher than normal.
authors: Department of Urology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, 46050 Kahramanmaras, Turkey.
authors: Erkan
authors: E
authors: Efe
authors: Sefa
authors: S
authors: Resim
authors: Burak Besir
authors: BB
authors: Bulut
authors: Mustafa
authors: M
authors: Eren
authors: Mesut
authors: M
authors: Garipardic
authors: Fuat
authors: F
authors: Ozkan
authors: Keramettin Ugur
authors: KU
authors: Ozkan
mesh_terms: D000772:Anesthesia, Local / Q000009:adverse effects*; D002648:Child; D002944:Circumcision, Male / Q000009:adverse effects*; D017984:Enoxaparin / Q000008:administration & dosage*; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D007511:Ischemia / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000187:drug effects; D011183:Postoperative Complications / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018615:Ultrasonography, Doppler, Color
chemical_list: D017984:Enoxaparin; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; C036309:fibrin fragment D; D008012:Lidocaine; D004837:Epinephrine