title: Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure.
abstract: OBJECTIVE
  More than 7000 male circumcisions are performed in Scandinavia every year. Circumcision is regulated in different ways in Sweden and Denmark and Norway. This study reviewed and described factors associated with complications of circumcision in infant boys in Scandinavia over the last two decades and discussed how these complications could be avoided.
  
  
  METHODS
  Data on significant complications following circumcision on boys under the age of one in Scandinavia over the last 20 years were collected. Information was retrieved from testimonies of circumcisers, witnesses, medical records and verdicts. A systematic review was performed of fatal cases in the literature.
  
  
  RESULTS
  We found that 32 cases had been reported to the health authorities in the three countries, and we identified a total of 74 complications in these cases. These included four boys with severe bleeding and circulatory shock, which ended in the death of one boy. Other less serious complications may have occurred in other boys, but not been reported.
  
  
  CONCLUSIONS
  Complications following male circumcision in Scandinavia were relatively rare, but serious complications did occur. Based on the analyses of the severe cases, we argue that circumcision should only be performed at hospitals with 24-hour emergency departments.
authors.affiliation: Department of Clinical Science, Paediatrics, Umeå University, Umeå, Sweden.
authors.forename: Gertrud
authors.initials: G
authors.lastname: Edler
authors.affiliation: Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden.
authors.forename: Inge
authors.initials: I
authors.lastname: Axelsson
authors.affiliation: Department of Women's and Children's Health, Paediatric Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Barker
authors.affiliation: Department for special health service, Norwegian Board of Health Supervision, Oslo, Norway.
authors.forename: Susanne
authors.initials: S
authors.lastname: Lie
authors.affiliation: Department of Clinical Science, Paediatrics, Umeå University, Umeå, Sweden.|Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden.
authors.forename: Estelle
authors.initials: E
authors.lastname: Naumburg
mesh_terms: D002944:Circumcision, Male / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology
keywords: Circulatory shock; Infant circumcision; Medical malpractice; Neonatal complications; Severe bleeding