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.

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