A novel complication of self-circumcision: penile skin avulsion Kendi kendine sünnetin alışılmamış bir komplikasyonu: Penis derisi avülsiyonu Akif Koç Cizre State Hospital, Department of Urology, Şırnak, Turkey Özet T ıraş bıçağı ile kendi kendine sünnet girişimine bağlı komplikasyon gelişen 19 yaşındaki erkek hasta sunul- maktadır. Hastanın herhangi bir anestetik olmaksızın kendi kendine uyguladığı sünnet, penis derisinin ve önde- rinin laserasyonu ve avülsiyonu ile sonuçlanmıştır. Hasta kendi kendine sünnetten iki saat sonra kontrol altına alın- mış lokal kanama ile başvurdu. Hasta, yaşadığı bölgedeki genel sünnet yaşı dikkate alındığında duyduğu utanç nedeniyle kendi kendine sünnete kalkışmıştır. Acil olarak ameliyat odasına alınmıştır. Tampon amacıyla kullanılan bez parçası çözüldüğünde, belirgin kanama görülmemiş- tir. Öncelikle nekrotik doku alınmış, sonrasında sünnet ve penis derisinin avülsiyonunun onarımı yapılmıştır. Hasta operasyondan iki gün sonra komplikasyon olmaksızın taburcu edilmiştir. Anahtar sözcükler: Avülsiyon; kendi kendine sünnet; komplikasyon. Abstract The case of a 19-year-old man who suffered a complica- tion after attempting self-circumcision with a razor blade was presented. He performed self-circumcision without any anesthetic which resulted in a laceration and avulsion of the penile skin and foreskin. The patient presented with controlled local bleeding two hours after self-circum- cision. He attempted self-circumcision due to feelings of shame considering the usual age range of circumci- sion in his local area. He was admitted to the operation room urgently. There was no significant bleeding, when the piece of cloth that had been used for tampon was untied. Initially, the necrotic tissue was removed, then circumcision and repair of the penile skin avulsion were performed. He was discharged two days after operation without any complication. Key words: Self-circumcision; complication; avulsion. Olgu Sunumu Case Report Türk Üroloji Dergisi - Turkish Journal of Urology 2011;37(2):177-179 177 Submitted (Geliş tarihi): 06.05.2010 Accepted after revision (Düzeltme sonrası kabul tarihi): 18.07.2010 Circumcision is one of the most common surgical interventions performed for medical, social, and reli- gious reasons in many countries including Turkey. [1,2] It is usually performed in childhood by experienced medical staff or untrained people. [3] Reports on self- circumcision are scarce in literature. [1,3-7] Adult males comprised most of the cases, and they were reported to use medically unapproved plastic or metallic device for the procedure. [1,3,6] Some reported compli- cations of self-circumcision are bleeding, infection, urethral damage, penile strangulation, skin necrosis, laceration and necrotizing fasciitis. [1,3,5,7] Reasons for carrying out the procedure on one’s own are diverse including poor economic status, fear of the procedure, depression, etc. [4,5,7] In this case, we report a previ- ously unreported complication, which was penile skin avulsion, in a case of self-circumcision performed by a razor blade. Case report A 19-year-old man presented to the emergency department with complaint of local bleeding controlled via a tampon over the penile skin after a trial of self- circumcision with a razor blade two hours after pro- cedure. He was referred to the urology department for further management. The procedure led to laceration and avulsion of the penile skin and foreskin, and no local anesthetic had been applied prior to the proce- dure. Review of the patient’s medical history ruled out psychological and organic problems. He was a shep- herd and had just wanted to circumcise by himself due to feelings of shame considering the usual age range for the practice of circumcision in his local area. On presentation, the foreskin and penile skin were partly removed, and there was a tampon with a piece of cloth tied to the proximal site of incision to prevent bleed-