Korean J Pediatr.  2015 Apr;58(4):154-157. 10.3345/kjp.2015.58.4.154.

Urosepsis and postrenal acute renal failure in a neonate following circumcision with Plastibell device

• Kalyanaraman M
• McQueen D
• Sykes J
• Phatak T
• Malik F
• Raghava PS

• KMID: 1802616
• DOI: http://doi.org/10.3345/kjp.2015.58.4.154

Abstract

Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates.

Keyword

Male circumcision; Surgical instruments; Sepsis; Acute kidney injury; Pyelonephritis

MeSH Terms

Acute Kidney Injury*
Anesthesia, Local
Circumcision, Male*
Emergency Service, Hospital
Female
Foreskin
Hemorrhage
Humans
Infant, Newborn*
Male
Necrosis
Penis
Pyelonephritis
Renal Insufficiency
Respiration, Artificial
Resuscitation
Sepsis
Skin
Surgical Instruments
United States
Urethral Obstruction