Complications arising from circumcisions performed by untrained providers: 5 cases managed at a tertiary paediatric surgery unit in Addis, Ababa, Ethiopia

Abstract

Complications of circumcision are usually minor. Major complications with prolonged morbidity are rarely reported in well-re­sourced settings. However, unsafe circumcision is a problem in low-income countries. In this article, we share our recent experi­ences with this issue.

We illustrate the problem with 5 cases encountered at our institution in 2019. The patients in this series ranged from 2 months to 9 years of age, and 4 of the 5 patients were at least 5 years old. Four of the circumcisions were performed by traditional healers, and 1 was performed by an inadequately trained doctor. Phimosis is the most frequent complication. As described in the first case, phimosis presenting after traditional circumcision is often severe, with repair requiring general anaesthesia. The second child had an unusual presentation: incontinence due to severe meatal stenosis, which resulted in urinary obstruction and urethral calculi. The third child presented with the rare complication of a urethrocutaneous fistula arising from suture ligation obliterating the urethral lumen. Finally, 2 additional rare cases of complete glanular amputation are described.

A variety of complications occurred after circumcisions performed as part of traditional practice as well as by inexperienced providers. The scenario is worsened by late presentations to medical institutions. In our experiences, the delays further compli­cated management, as phimosis was not amenable to topical steroids, amputated glandes could not be primarily reattached, and simple meatal stenosis progressed to severe obstruction. Extensive work is required to train traditional healers in rural parts of the country.