Management of total penile amputation following circumcision in a resource-limited setting: A case report

Total penile amputation following circumcision is a rare complication. This case highlights the challenges associated with managing such a catastrophic injury in a resource-limited setting. A 46-day-old male was brought to our hospital with a five-day history of difficulty voiding, irritability, and bleeding from a circumcision done two weeks earlier by a traditional healer under suboptimal conditions. The mother reported a proper initial recovery but stated that the penis became followed by penile discolored and detached five days prior to presentation. Despite the severe injury, the patient had no fever or systemic symptoms. On admission, he was afebrile and pale. The perineal exam revealed a total penile amputation, and a nasogastric tube placed in the urethra at the referring hospital. Blood tests showed anemia (hemoglobin 8.2 g/dL) but normal renal function. The urinalysis was normal. An abdominal ultrasound (US) ruled out hydronephrosis. The patient received a blood transfusion, intravenous ceftriaxone, and pain medications. He was taken to the operating room for an exam under anesthesia. We did a debridement of the necrotic tissue and reconstructed the urethral opening with skin flaps. We left an 8 French nasogastric tube in the urethra. The postoperative recovery was uneventful. At three months of follow up, he has healed properly and has a patent neourethral meatus. Reconstruction of the urethral opening using locally mobilized skin flaps and urinary drainage via catheter placement can achieve satisfactory outcomes in infants with total penile amputation when advanced surgical resources are unavailable.