title: [An unexpected complication: glans ischemia after circumcision. Review of the literature].
abstract: BACKGROUND
  Circumcision is a frequent and common surgical procedure in children; nevertheless it is not completely hassle-free. Post circumcision ischemic complications are even rare and they are generally due to administration of local vasoconstrictor anesthetics. There are few cases reported in the literature. We report the management and treatment of post- circumcision penile ischemia (PCI).
  
  
  METHODS
  A 10 years old patient who underwent circumcision and a dorsal penile nerve block DPNB presents signs of penile ischemia two hours after surgery without any other symptoms. Ultrasonography shows weak flow of the penile artery, with progressive worsening. 24 hours later we start treatment with pentoxifylline (PTX) that is maintained for 6 days, topical testosterone and a caudal blocking (for 48 hours). The patient evolved favorably within a few hours and there was complete resolution in 6 days.
  
  
  CONCLUSIONS
  We analyze 9 cases of pediatric patients which were described in the literature. 7 cases (77.7 %) received DPNB. The PCI is an unusual complication of circumcision, and DPNB seems to be the most frequent cause. Several therapeutic options are available for its management, but none is protocolised.
authors.affiliation: UGC Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Cárdenas Elías
authors.affiliation: UGC Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba. Facultad de Medicina. Universidad de Córdoba (UCO). Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC).
authors.forename: F
authors.initials: F
authors.lastname: Vázquez Rueda
authors.affiliation: UGC Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba.
authors.forename: V
authors.initials: V
authors.lastname: Jiménez Crespo
authors.affiliation: UGC Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba.
authors.forename: A
authors.initials: A
authors.lastname: Siu Uribe
authors.affiliation: UGC Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba.
authors.forename: F J
authors.initials: FJ
authors.lastname: Murcia Pascual
authors.affiliation: UGC Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba.
authors.forename: J E
authors.initials: JE
authors.lastname: Betancourth Alvarenga
authors.affiliation: UGC Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba.
authors.forename: R M
authors.initials: RM
authors.lastname: Paredes Esteban
mesh_terms: D000779:Anesthetics, Local; D002648:Child; D002944:Circumcision, Male / Q000009:adverse effects*; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000628:therapy; D008297:Male; D009407:Nerve Block; D010413:Penis / Q000098:blood supply*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy
chemical_list: D000779:Anesthetics, Local
keywords: Circumcision; Dorsal penile nerve block; Penile ischemia