Mohamed Shukri Said, Sheikh Omar Adam, Adam Mesut Kayse, Ali Abdullahi Yusuf, Mohamed Abdikarim Hussein, Mead Ahmed
Department of Pediatric Surgery, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia.
Faculty of Medicine, Department of Basic Medical Science, Somali National University, Mogadishu, Somalia.
Ann Med Surg (Lond). 2022 Nov 12;84:104872. doi: 10.1016/j.amsu.2022.104872. eCollection 2022 Dec.
Traditional circumcisions may cause complications such as hemorrhage, infection, amputations of the penis, meatal stenosis, and urethro-cutaneous fistula. In addition to all these complications, iatrogenic hypospadias, as in our case, is a rare condition. In general, complications are mild and preventable, especially in children, but when the procedure is carried out by unskilled providers, in unsterile conditions, or with inadequate equipment and supplies, severe complications are more likely to occur. Several degrees of urethral erosion, including iatrogenic hypospadias, might result from further injury. Particularly in intensive care facilities, the ventral male urethra can undergo this kind of trauma.
A 4-year-old child was circumcised at the age of 3 years, and after that, he bled profusely. His parents brought him to the hospital after 4 months. On physical examination of the patient, the glans was normal but there was an opening near the glans in the distal urethra at the subcoronal level. After the pre-operative check-up, the patient was prepared for elective surgery. An incision and dissection were performed to reveal the fistula tract all around by placing marker sutures from the edges of the fistula. The fistula opening was repaired with 6/0 PDS (polydioxanone) and a second layer was created over the urethral fistula repair, and then the skin was closed with 4/0 Vicryl (polyglactin).
Around the world, circumcision continues to be the most common procedure done on children. Injuries to the penis may actually happen with a 1% complication incidence. A poorly placed suture at the frenulum in an effort to achieve hemostasis is the most frequent cause of the fistula. This causes strangulation and necrosis of a portion of the urethral wall, which leads to the creation of a sub glandular fistula. It is important to properly identify and treat any life-threatening injuries to the urethra as soon as possible.
Considered a medical procedure that necessitates great care, circumcision should only be carried out by qualified surgeons under sterile hospital circumstances. Most circumcision-related injuries result from clamp circumcisions (such as Mogen or Gomco), and they can range from minor loss of penile skin to more serious glans, distal urethral, and penile shaft injuries.
传统包皮环切术可能导致出血、感染、阴茎截肢、尿道口狭窄和尿道皮肤瘘等并发症。除了所有这些并发症外，如我们病例中的医源性尿道下裂是一种罕见情况。一般来说，并发症较轻且可预防，尤其是在儿童中，但当由不熟练的医疗人员在非无菌条件下或使用不足的设备及用品进行手术时，更可能发生严重并发症。进一步的损伤可能导致包括医源性尿道下裂在内的不同程度的尿道侵蚀。特别是在重症监护病房，男性腹侧尿道可能遭受此类创伤。
一名4岁儿童在3岁时接受了包皮环切术，术后大量出血。4个月后其父母带他到医院。对该患者进行体格检查时，龟头正常，但在冠状沟下水平的尿道远端靠近龟头处有一个开口。术前检查后，患者准备接受择期手术。通过从瘘口边缘放置标记缝线进行切口和分离，以暴露周围的瘘管通道。用6/0聚二氧六环酮（PDS）修复瘘口，并在尿道瘘修复上方构建第二层，然后用4/0聚乙醇酸（Vicryl）缝合皮肤。
在世界各地，包皮环切术仍然是对儿童进行的最常见手术。阴茎损伤实际发生率可能为1%。为实现止血而在系带处缝合位置不当是瘘管最常见的原因。这会导致尿道壁一部分发生绞窄和坏死，从而形成腺下瘘。尽快正确识别和治疗任何危及生命的尿道损伤非常重要。
包皮环切术被认为是一项需要格外小心的医疗程序，应仅由合格的外科医生在医院无菌环境下进行。大多数与包皮环切术相关的损伤是由钳夹式包皮环切术（如莫根或戈姆科式）导致的，损伤范围从阴茎皮肤轻度缺失到更严重的龟头、尿道远端和阴茎体损伤。
