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CASE REPORT |
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Year : 2014 | Volume
: 7
| Issue : 2 | Page : 243-245 |
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An accidental finding of a penile abscess in a febrile sickle cell anaemia child following circumcision
Aliyu Ibrahim
Department of Paediatrics, Consultant Paediatrician, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
Date of Web Publication | 4-Feb-2014 |
Correspondence Address: Aliyu Ibrahim Department of Paediatrics, Aminu Kano Teaching Hospital, Kano Nigeria
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.126370
Circumcision is an age-long tradition in Africa. Both sexes are often circumcised; however, female circumcision has significantly reduced in some African societies while the practice of male circumcision still continues. Be that as it may, there are documented health benefits of male circumcision such as less risk of urinary tract infection, penile cancer, and transmission of human papilloma viral infection; however, if poorly done it may have severe complications such as bleeding, penile infections (tetanus) and abscess, and penile amputation. Circumcision is commonly done by traditional barbers in many African communities where health facilities are scares; therefore, if their practices are not regulated and improved the risk of complication is heightened. Though complications may set in following circumcision in hospital especially where proper patient preparation and infection control measures are not put in place. Penile abscess may occur in sickle cell anemic patients following priapism or its medical intervention; this may be due to haematogeneous bacterial seeding of necrotic penile tissues or direct inoculation following therapeutic intervention such as intracorporeal injection. However, a 6-year-old sickle cell anemic boy diagnosed with vaso-occlusive crisis but later noticed to have penile abscess following circumcision done in a hospital is reported. Keywords: circumcision, penile abscess, sickle cell anaemia
How to cite this article: Ibrahim A. An accidental finding of a penile abscess in a febrile sickle cell anaemia child following circumcision. Med J DY Patil Univ 2014;7:243-5 |
Introduction | | |
Penile abscess is rare, [1] it is mostly associated with penile trauma, penile fracture, priapism, injection into the corpora carvonosa, following procedures such as cavernosography and as a complication of penile foreign body. [2],[3],[4] Furthermore, it may be associated with septicemia in immunosuppressed patients. [5]
Sickle cell anaemic patients are prone to priapism which occur in 35% of cases [6] and penile abscess may complicate priapism. This is due to the hematogenous seeding of microbes into necrotic tissues and it may also follow direct inoculation of microbes during therapeutic intervention like intracorporeal injection. However, a rare case of penile abscess is reported in a 6-year-old sickle cell anaemic boy whose diagnosis of penile abscess following circumcision was accidental after been managed for vaso-occlusive crisis.
Case Report | | |
Six-year-old sickle cell anaemic boy presented with fever for 5 days; he had no cough or difficulty in breathing, and there was no history of dysuria or jaundice; he also complained of both leg pains that were also tender but there were no swellings. The child had been on antimalaria on out-patient bases and made no significant improvement. There was no history of painful erection before or during the course of the illness but he had circumcision 10 days (indication been in fulfillment of his religious rites) before the onset of fever. Circumcision was done in a general hospital and daily dressing was prescribed which was not regularly done because the parents felt the wound was healing. On examination, the main finding was the fever of 39°C, tenderness on both legs. Circumcision site superficially appeared clean and healing; the malaria parasite (MP) test was negative and full blood count (FBC) showed absolute neutrophilia. A diagnosis of vaso- occlusive crisis was made and he had IV fluids, analgesia, and ampicillin and cloxacillin. Fever persisted and on further review, the attending physician notice a small bump on the dorsum of the distal end of the shaft of the penis which was squeezed and pus exuded [Figure 1] and [Figure 2]; it was aspirated and 5 ml of pus was drained. Sample was sent for culture and it yielded Staphylococcus aureus, sensitive to ampicillin and cloxacillin that he was already on. He improved remarkably and was discharged after 1 week on admission.
Discussion | | |
Male child circumcision is a common practice in most African culture and some religion; while it may not be mandatory in some societies, reports have associated male circumcision with some health benefits such as less risk of urinary tract infection, penile cancer, and transmission of human papilloma viral infection. [7],[8] But this supposed simple surgical procedure may be fraught with complications in about 20.2% of cases; [9] among the common complications reported by Hutcheson were bleeding, amputation of the glans penis, and infection. [10] Though other organisms have been implicated but in the index case, Staphylococcus aureus was isolated similar to that reported by Sagar et al. [1]
The possible source of the infection in this case was from circumcision site, more so the parents were not observant else they could have noticed the swelling; though the child did not specifically complain of penile pain that probably was overshadowed by the severe limb pains from vaso-occlusive crisis.
This case highlights the importance of thorough physical examination, because on the surface the circumcision appeared healing. While male circumcision is still practiced in both developed and developing countries, efforts should be made to make it as safe as possible. In local African communities, it is often done by local barbers with its attendant risk of complications.
In this index case, despite the surgery been done in the hospital, the subject still came down with infection; the parents were not regular with wound dressing because they felt the wound was healing. Probably they were not properly counseled; though some parents may refuse to follow instructions despite a well done counseling. Therefore, parents should be adequately counseled on the importance of personal hygiene, the need to adhering to medical prescription, and the relevance of completing medical treatment in order to avoid these mishaps. Counseling should never be done in a hurry therefore there should be feedback mechanisms that ensure that messages are properly delivered and understood by patients and caregivers.
Conclusion | | |
Circumcision is an age-long practice, while success has been achieved in containing female circumcision; male circumcision is still ongoing for several medical, religious, and traditional reasons. While the practice continues, it should be as safe as possible and physicians should be on the lookout for possible complications; there should be infection control measures put in place and parents should be adequately enlightened on the importance of personal hygiene and the need to adhere to doctor's prescription. The patronage of traditional barbers for circumcision should be discourage but in traditional African societies where they are highly regarded for their traditionally believes, their practices should be monitored and made safer.
References | | |
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7. | Way A, Misha V, Johnson K. Is male circumcision protective of HIV infection? AIDS 2006XVI International AIDS Conference. 2006. |
8. | Okeke L, Asinobi AA, Ikuerowo OS. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol 2006;6:21. Available from: http://www.biomedcentral.com/1471-2490/6/21 [Last accessed on 2013 Oct 1]. |
9. | Ben CJ, Livne PM, Binyamini J, Hardak B, Ben-Meir D, Mor Y. Complications of circumcision in Israel: A one year multicenter survey. Isr Med Assoc J 2005;7:368-70. |
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[Figure 1], [Figure 2]
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