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Education And Debate

Lesson of the Week: Male ritual circumcision resulting in acute renal failure

BMJ 1994; 309 doi: (Published 10 September 1994) Cite this as: BMJ 1994;309:660
  1. J D Eason,
  2. M McDonnell,
  3. G Clark
  1. Department of Paediatric Nephrology and Optimum Health Services, Guy's Hospital, London SE1 9RT
  1. Correspondence to: Dr Clark.
  • Accepted 3 March 1994

Male ritual circumcision is commonplace in the British community, especially among those of Jewish and Muslim faiths and certain immigrant populations such as West Africans. We report three cases of circumcision performed in the community in which the parents were not warned about complications and which resulted in prolonged urinary retention and acute renal failure.

Case reports Case 1

A 15 day old baby was admitted with a four day history of increasing vomiting and abdominal distension. After a normal pregnancy and birth he had been admitted to this hospital's special care baby unit for one day because of tachypnoea, grunting, and poor feeding. He had been circumcised by a local community rabbi at 11 days of age. Increasing vomiting and abdominal distension were subsequently noted, but he continued to feed well. His mother thought that he was passing urine normally.

On physical examination he had a pulse rate of 140 beats/min, warm hands and feet, a blood pressure of 77/52 mm Hg, and a respiratory rate of 28 per minute. The bladder was palpable above the umbilicus, but the abdomen wall was soft with normal bowel sounds. His penis was tightly bandaged, and the circumcision wound was inflammed and purulent. Table I shows the results of his initial renal function tests.

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Result of biochemical tests and tests of renal function on admission in three …

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