Contact Angioedema of Male Genitalia after use of Emla Cream Towards Routine Neonatal Circumcision
Sody Naimer and Yuri Zeldin
World Journal of Medical and Surgical Case Reports 2013, 2:7
Routine neonatal circumcision is commonly performed under topical anesthesia with a eutectic mixture of lidocaine and prilocaine (EMLA). We report that such anesthesia runs the risk of complications that may actually impede the performance of this procedure in the event of a hypersensitivity reaction. We report to our knowledge the first case of contact angioedema in a neonate towards routine circumcision.
After 30 weeks of gestation, a first born male premature infant weighing 1,230 grams was born with esophageal atresia and duodenal obstruction. At the age of two days a gastrostomy feeding tube was inserted and he was transferred from a local to a major medical center for correction of a tracheo- esophageal fistula and a right inguinal hernia. Following thoracotomy and herniorhaphy, eventually the feeding tube was removed. He gradually improved and at 6 months old the baby was recommended to perform circumcision. Emla cream was applied with polyethylene sheet closure one hour before the procedure. At the ceremony hall, upon exposure the genitalia was revealed an open prepuce with swelling extending towards the proximal shaft precluding any possibility of inserting the guard traditionally used in guillotine circumcision. Subsequently some of the swelling subsided and patiently waiting allowed guard insertion and successful routine circumcision despite the ensuing swelling.
This case stresses the importance of adherence to instructions and appropriate follow up when prescribing medication even for topical use. EMLA cream should be used judiciously due to its possible risk of immediate allergic reaction.
Prepuce excision, topical anesthesia, penile hypersensitivity, allergic reaction.