Botched Circumcision of a Newborn Male Patient Results in Permanent Lifelong Deformity

This case involves a botched circumcision of a newborn male patient. The physician used a Plastibell Circumcision Device and it appears that the Plastibell ring used was the wrong size, which in turn caused this adverse outcome. The glans of the penis have a large indentation half way through, which will be a permanent lifelong deformity.

Question(s) For Expert Witness

1. What steps should be taken to ensure the correct ring size of the device is chosen?

Expert Witness Response E-000095

Plastibell circumcision is a simple technique for neonatal circumcision. However, the complications of this technique can sometimes be life-threatening and one should take great care in choosing the correct ring size. The reported complications of Plastibell circumcisions range from minor ones to more serious ones. Complications of concern that have been reported in the literature include proximal migration of the bell onto the distal penile shaft causing circumferential compression; denution of penile skin or persistent disfigurement of the glans penis. The commonest Plastibell ring size used was 1.3 cm with sizes ranging from 1.1 to 1.7 cm. The foreskin is freed off the entire glans and completely retracted to expose the whole glans, then the correct size Plastibell is selected by testing it directly on the glans. The foreskin is pulled over the Plastibell which is stabilized by a hemostat clamping the skin to the handle of the Plastibell. The foreskin is excised just past the outermost edge of the Plastibell taking care not to damage the glans. Final checking for bleeding, metal opening and correct position of the tie is performed at the end of the procedure and any damage should be noticed right away.