Clinician to Clinician: Beware the dark glans penis


I was on general obstetric call at our suburban hospital in Minnesota when I entered the nursery one day in 2002. That morning, circumcisions needed to be done on several 1-day-old boys. Per the routine, I confirmed the infants' identification and consent status and commenced with the procedures, for which I use the Gomco clamp technique.

Then I noticed that one infant had an unusually dark glans penis. At first, I feared that I had used 1% lidocaine with epinephrine, rather than plain, for the dorsal penile block. But I had checked the solution before the procedure and I rechecked it: No problem. Next, I wondered whether the young man had received some genes from darker-skinned ancestors of whom I was unaware. (The baby's name sounded Scandinavian and my colleagues had done the informed consent.)

I finished the procedure without complication and the baby did fine. My parting comment to the nursery nurse was, "Wouldn't it be unusual if this baby had some right-to-left shunting congenital heart disease that was causing peripheral cyanosis?" Sure enough, a few hours later, the baby experienced respiratory distress and was diagnosed with hypoplastic left heart syndrome.

CLINICIAN TO CLINICIAN offers the hard-won wisdom and expertise of physicians "in the trenches." We're looking for unusual case reports, anecdotes about innovative treatments, and practical solutions for professional problems from community physicians. Send your submission of 750 words or less to Editor in Chief Charles J. Lockwood, MD, by e-mail (
) fax (973-847-5340) or mail (5 Paragon Drive, Montvale, NJ 07645). All submissions are subject to peer review by the Contemporary OB/GYN Editorial Board. Nevertheless, the concepts discussed may be anecdotal in nature.

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