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Bergus K, Frooman A, Castellanos S, Thakkar R, McCracken K, Kebodeaux C, Hewitt G, Schwartz D, Fei YF. Characterization of Pediatric Female Genital Trauma Using a Novel Grading System and Recommendations for Management. J Pediatr Surg 2024:S0022-3468(24)00366-X. [PMID: 38969591 DOI: 10.1016/j.jpedsurg.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/31/2024] [Accepted: 06/10/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND There is no standardized grading system for pediatric female genital trauma (PFGT), so patients may have over-utilization of resources relative to injury severity. We described current treatment patterns and outcomes at a high-volume trauma center, developed a novel PFGT grading system, and proposed algorithm for management of PFGT. METHODS We retrospectively reviewed female patients <19 years presenting with genital trauma to our Level 1 pediatric trauma center between 1/2018-12/2022. A novel grading system developed by pediatric surgery and pediatric gynecology was retrospectively applied to injuries. Patient demographics, injury characteristics, types of intervention, and need for anesthesia were recorded. Outcomes were compared between grades of injury with Kruskal-Wallis tests. RESULTS Among 353 patients, median age was 6.4 years. Half of patients had grade 1 or 2 injuries, of which 6% required suture repair. 15% of patients had grade 5 or 6 injuries, 75% of whom required suture repair. General anesthesia was used for 83% of all patients undergoing repair. 18% of patients who underwent general anesthesia did not need suture repair. Of patients who were brought to the operating room, median operative duration varied by grade and was 15.0 min for all injuries, 7.0 min for both grade 1 and 2 injuries, and 22.0 and 37.0 min for grade 5 and 6 injuries, respectively (p < 0.0001). CONCLUSIONS Based on our novel grading system, we propose an algorithm for managing PFGT. Grade 1 and 2 injuries rarely require suture repair and can often be managed without surgical consultation. We recommend surgical consultation for higher grade injuries, however given typically short operative times, repair with bedside sedation should be strongly considered when resources allow. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Katherine Bergus
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Abigail Frooman
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Sydney Castellanos
- The Ohio State University School of Medicine, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Rajan Thakkar
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Kate McCracken
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Chelsea Kebodeaux
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Geri Hewitt
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Dana Schwartz
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Y Frances Fei
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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McLaughlin CJ, Martin KL. Mechanism of Injury and Age Predict Operative Intervention in Pediatric Perineal Injury. Pediatr Emerg Care 2023; 39:230-235. [PMID: 36892540 DOI: 10.1097/pec.0000000000002928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVES Literature characterizing pediatric perineal trauma is sparse and generally limited to females. The purpose of this study was to characterize pediatric perineal injuries with specific focus on patient demographics, mechanisms of injury, and care patterns at a regional level 1 pediatric trauma center. METHODS Retrospective review of children aged younger than 18 years evaluated at a level 1 pediatric trauma center from 2006 to 2017. Patients were identified by International Classification of Diseases-9 and 10 codes. Extracted data included demographics, injury mechanism, diagnostic studies, hospital course, and structures injured. The χ 2 and t tests were used to examine differences between subgroups. Machine learning was used to predict variable importance in determining the need for operative interventions. RESULTS One hundred ninety-seven patients met inclusion criteria. Mean age was 8.5 years. A total of 50.8% were girls. Blunt trauma accounted for 83.8% of injuries. Motor vehicle collisions and foreign bodies were more common in patients aged 12 years and older, whereas falls and bicycle-related injuries were more common in those younger than 12 years ( P < 0.01). Patients younger than 12 years were more likely to sustain blunt trauma with isolated external genital injuries ( P < 0.01). Patients aged 12 and older had a higher incidence of pelvic fractures, bladder/urethral injuries, and colorectal injuries, suggesting more severe injury patterns ( P < 0.01). Half of patients required operative intervention. Children aged 3 years or younger and older than 12 years had longer mean hospital stays compared with children aged 4 to 11 years ( P < 0.01). Mechanism of injury and age constituted more than 75% of the variable importance in predicting operative intervention. CONCLUSIONS Perineal trauma in children varies by age, sex, and mechanism. Blunt mechanisms are the most common, with patients frequently requiring surgical intervention. Mechanism of injury and age may be important in deciding which patients will require operative intervention. This study describes injury patterns in pediatric perineal trauma that can be used to guide future practice and inform injury prevention efforts.
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Affiliation(s)
| | - Kathryn L Martin
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA
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Surgical management of traumatic perineal injury in female children: A report of two cases. Int J Surg Case Rep 2023; 103:107874. [PMID: 36642025 PMCID: PMC9845951 DOI: 10.1016/j.ijscr.2023.107874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/31/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Perineal trauma is uncommon in paediatric population,accounting for about 0.2 to 8 % of all paediatric trauma. The goal of surgical management is to ensure adequate anatomical reconstruction with good functional outcome and cosmesis. A novel surgical technique derived from posterior sagittal anorectoplasty (PSARP)was recently described for reconstruction of perineal injuries due to sexual assault in children. We report our experience with the utilization of this technique for perineal reconstruction in 2 girls with fourth-degree traumatic genito-anal injury. CASE PRESENTATION The first patient is a 6 year old girl who presented 2 months post perineal injury following a fall.Previous multiple attempts at repair in peripheral hospital failed.She had Initial debridement,wound irrigation and divided sigmoid colostomy for stool diversion done.Definitive reconstruction was performed 5 months later.The second patient is a 14 year old girl that presented 6 days following perineal trauma sustained while riding a bicycle.Primary repair was also attempted before referral,with subsequent wound breakdown.Wound debridement and colostomy creation was done and surgical reconstruction carried out 6 months later.Following definitive repair,the colostomies in both patients were closed at 2 and 3 months respectively.Both patients are fully continent of stool and have excellent cosmetic outcome during postoperative follow up. CLINICAL DISCUSSION The surgical technique allows for effective dissection and proper reconstruction of the perineal body and anorectal sphincters.It also avoids unnecessary dissection and tissue disruption as the intact posterior rectal wall and anal sphincters are left undisturbed. CONCLUSION The Surgical technique derived from the principles of posterior sagittal anorectoplasty gives excellent functional outcome in perineal trauma.
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Hoshi R, Uehara S, Hashimoto M, Hosokawa T, Kawashima H, Kaneda H, Hoshino M, Koshinaga T. Diagnosis and management of genital injuries in girls: 14-year experience. Pediatr Int 2021; 63:523-528. [PMID: 32853468 DOI: 10.1111/ped.14448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric patients with genital injuries are often recommended to receive an examination under general anesthesia; however, detailed clinical data of such patients are rarely reported. METHODS A single-center retrospective review was conducted in 45 girls less than 16 years of age with genital injuries between January 2005 and December 2018. RESULTS The median patient age was 5.0 years. Forty-two patients were hospitalized, of whom 38 required an examination under general anesthesia and all consequently required surgical repair. The diagnosis obtained after a thorough examination under general anesthesia was inconsistent with the diagnosis obtained at the emergency room in five patients. In 20 patients, the source of bleeding was not clarified at the time of initial examination at the emergency room; four of these patients were later revealed to have vaginal or rectal injuries that had been overlooked during the examination at the emergency room. Injuries occurring in the bathroom were the most frequent and tended to be serious. Multiple injuries were found in 10 patients. The exterior of the labia minora was the most commonly injured site, found in 18 patients. CONCLUSIONS We analyzed the clinical data of girls with genital injuries in detail, which allowed us to find a detailed classification of injured sites and the characteristics of serious cases, and to re-recognize the importance of a thorough examination under general anesthesia.
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Affiliation(s)
- Reina Hoshi
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Hashimoto
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Hosokawa
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Kawashima
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hide Kaneda
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mayumi Hoshino
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tsugumichi Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
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Glaser ZA, Singh N, Koch C, Dangle PP. Pediatric female genital trauma managed under conscious sedation in the emergency department versus general anesthesia in the operating room- a single center comparison of outcomes and cost. J Pediatr Urol 2021; 17:236.e1-236.e8. [PMID: 33483294 DOI: 10.1016/j.jpurol.2020.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/31/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pediatric female genital trauma (PFGT) comprises injuries to the female external and internal genitalia. Examination under general anesthesia (GA) in the operating room (OR) is traditionally recommended, however repair at the bedside under conscious sedation (CS) in the emergency department (ED) may be a safe alternative. The Genitourinary Injury Score (GIS) objectively classifies PFGT severity, but designates all vaginal and urethral injuries as Grade III. OBJECTIVE To compare outcomes and cost of patients with PFGT managed under CS in the ED vs GA in the OR. STUDY DESIGN All patients treated by a pediatric urologist from May 2009 to September 2019 with associated ICD codes for PFGT were included. Exclusion criteria included PFGT from sexual abuse or obstetric related complications. Clinical and demographic data was extracted from the EMR. A cost analysis comparing ED vs OR management was performed. RESULTS 33 patients were identified with a median age of 6.8 years. The primary etiology was straddle trauma. Injuries were predominately GIS I-III (30, 91%) with possible urethral involvement in 6 patients. Sedation and repair in the ED was performed for 12 (36%) patients vs 21 (64%) taken to the OR. For the OR cohort, 15 (71%) were taken to the OR immediately and 6 (29%) initially underwent CS but this was aborted due to injury complexity. Aborting CS and proceeding to the OR did not result in compromised outcome or prolonged hospitalization. No patients in the ED cohort required post-procedural admission whereas all patients taken to the OR were admitted postoperatively. Cost of care for ED repair was less than two-thirds (60%) that of surgical repair in the OR. Using Onen GIS III or less without deep vaginal and/or urethral involvement as a cutoff for attempted bedside repair vs proceeding directly to the OR could have spared 7 (47%) patients GA and subsequent admission. A female-specific modification to the Onen GIS III criteria is proposed in light of these findings. DISCUSSION The present study suggests CS and bedside repair of low-grade PFGTs is safe with a cost benefit. This is reflected by a proposed modification to the Onen GIS III criteria. These findings should be interpreted with caution given the retrospective nature of this single institution, small cohort study. CONCLUSION CS and bedside repair of low-grade PFGT appears to be safe and cost effective. Delineating GIS III injuries according to urethra and/or deep vaginal involvement may improve the GIS scale's clinical utility.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Nikhi Singh
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Connor Koch
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Pankaj P Dangle
- Department of Urology, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
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Brisighelli G, Etwire V, Lawal T, Arnold M, Westgarth-Taylor C. Treating pediatric colorectal patients in low and middle income settings: Creative adaptation to the resources available. Semin Pediatr Surg 2020; 29:150989. [PMID: 33288130 DOI: 10.1016/j.sempedsurg.2020.150989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Colorectal disease profiles for children in low- and middle-income settings (LMIC) are characterized by late presentation, increased complications and limited follow-up in many cases. There is a high prevalence of infectious conditions causing secondary colorectal disease such as Mycobacterium Tuberculosis(TB), Human Immunodeficiency Virus(HIV) and Human Papilloma Virus(HPV), which also impact the management of other primary colorectal conditions, such as wound-healing and intestinal anastomosis. Perineal trauma from sexual assault, motor vehicle or pedestrian accidents, burns, and traditional enemas are commonly encountered and may require adaptation of principles used in treatment of congenital anomalies such as Hirschsprung's disease and Anorectal Malformations for reconstruction. Endemic conditions in certain LMIC require further research to delineate underlying causes and optimize management, such as "African" degenerative visceral leiomyopathy, congenital pouch colon in the Indian subcontinent, and congenital H-type rectal fistulae prevalent in Asia. These unique disease profiles require creative adaptations of resources within poor healthcare infrastructure settings. These special challenges and pitfalls in colorectal care and complications of adverse socioeconomic conditions, are discussed.
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Affiliation(s)
- Giulia Brisighelli
- Department of Pediatric Surgery, Pediatric Colorectal and Pelvic Reconstruction Centre, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.
| | - Victor Etwire
- Department of Surgery, Pediatric Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Taiwo Lawal
- Division of Pediatric Surgery, University College Hospital and Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | - Marion Arnold
- Division of Pediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Chris Westgarth-Taylor
- Department of Pediatric Surgery, Pediatric Colorectal and Pelvic Reconstruction Centre, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa
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Brisighelli G, Levitt MA, Wood RJ, Westgarth-Taylor CJ. A Surgical Technique to Repair Perineal Body Disruption Secondary to Sexual Assault. European J Pediatr Surg Rep 2020; 8:e27-e31. [PMID: 32550122 PMCID: PMC7188516 DOI: 10.1055/s-0039-1695048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/08/2019] [Indexed: 10/25/2022] Open
Abstract
Perineal trauma is uncommon in the pediatric population and it is estimated that 5 to 21% is secondary to sexual abuse. We aim to present a proposed surgical technique to repair perineal injuries secondary to sexual assault in female children. The technique is based on the posterior sagittal anorectoplasty (PSARP) for repairing anorectal malformations and, between 2017 and 2019, it was used to treat three girls (2 months, 2 years, and 8 years of age) with fourth-degree perineal injuries secondary to sexual assault. One of them underwent laparotomy and Hartmann's colostomy for an acute abdomen. Two underwent wound debridement and suturing and only had a stoma fashioned at 5 days and 6 weeks posttrauma, respectively. The perineal repair was performed 2, 6, and 7 weeks postinjury and done as follows: with the child prone in jack-knife position, stay-sutures are placed on the common wall between the rectum and the vagina. Using a needle tip diathermy, a transverse incision is performed below the sutures lifting the anterior rectal wall up. Stay sutures are then positioned on the posterior wall of the vaginal mucosa. The incision between the walls is deepened until the rectum and the vagina are completely separated. The deep and superficial perineal body is then reconstructed using absorbable sutures and an anterior anoplasty and an introitoplasty are performed. The stoma in each was closed 6 weeks postreconstruction. At follow-up, now 1 year or more postrepair, all patients have an excellent cosmetic outcome and are fully continent for stools.
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Affiliation(s)
- Giulia Brisighelli
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Marc A Levitt
- Department of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington DC, United States
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Christopher J Westgarth-Taylor
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Bakal U, Sarac M, Tartar T, Cigsar EB, Kazez A. Twenty years of experience with perineal injury in children. Eur J Trauma Emerg Surg 2015; 42:599-603. [DOI: 10.1007/s00068-015-0576-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/19/2015] [Indexed: 11/24/2022]
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Roland D, Lewis G, Rowlands R, Davidson E, Davies F. Female perineal injuries in children and adolescents presenting to a paediatric emergency department. Emerg Med J 2015; 33:73-5. [DOI: 10.1136/emermed-2014-204259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/18/2015] [Indexed: 11/04/2022]
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Straddle injuries in female children and adolescents: 10-year accident and management analysis. Indian J Pediatr 2014; 81:766-9. [PMID: 23824694 DOI: 10.1007/s12098-013-1096-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyze unintentional straddle injuries in girls with regards to epidemiology, etiology and injury management. METHODS The hospital database was retrospectively reviewed (1999-2009) for female patients managed for genital trauma. Patients were evaluated based on age, causative factors, type of injury, area of genitals affected, management and outcomes. RESULTS Straddle injuries were documented in 91 girls with age ranging from 1 to 15 y (mean = 6.3 y; median = 6.1 y). The causes of injuries were falls at home (n = 31) or outdoors (n = 27), and sport activities (swimming pool n = 11, skating n = 11, bicycle n = 9 and scooter n = 2). Most of the injuries were lacerations. Injuries involved major labia (n = 56), minor labia (n = 45) and introitus vaginae (n = 15). Twelve children received outpatient treatment. Inspection under anesthesia was performed in 79 patients, with 76 requiring sutures. While hematuria was observed in 18 patients, cystoscopy did not reveal lesions in the urethra or bladder. Associated injuries were femur fracture (n = 1), lower extremity lacerations (n = 4) and anal lesions (n = 2). Follow-up investigations were uneventful; however one patient developed a secondary abscess and another secondary hyperplasia of the labia minor. CONCLUSIONS Falls and sports are major causes of straddle injuries with a peak at the age of six years. Lacerations are the most common injuries and often require surgical management. Urinary tract injuries and other associated injuries are relatively uncommon in girls with straddle injuries.
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Kim K, No JH, Kim YB, Lee JH, Rhee JE. Patterns of accidental genital trauma and factors associated with surgical management in girls visiting the emergency department of a referral center. J Pediatr Adolesc Gynecol 2014; 27:133-7. [PMID: 24656698 DOI: 10.1016/j.jpag.2013.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 09/06/2013] [Accepted: 09/12/2013] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To examine our experience with the management of accidental genital trauma (AGT) and to identify variables associated with surgical management or admission in girls aged ≤15 y. DESIGN A retrospective, observational study. SETTING Tertiary referral hospital. PARTICIPANTS Girls with AGT visiting the emergency department (ED) between 2003 and 2011. INTERVENTIONS None. MAIN OUTCOME MEASURES Admission rate and surgery rate. RESULTS AGT was the cause in 159 out of 327 girls (49%) who visited the Gynecologic Division of ED; and in girls aged ≤10 years, AGT accounted for 78% of the visits (145/187). Twenty girls (13%) were admitted to the hospital and 38 girls (24%) underwent surgical management. Girls who visited the ED during daytime and those with laceration-type or large lesions tended to receive surgical management. Girls with large lesions also tended to be admitted to the hospital. CONCLUSION AGT is the major gynecologic cause of ED visits in girls. Time of visit, type and size of lesion were associated with surgical management. Lesion size was also a determinant for admission in girls with AGT. Gynecologists must be familiar with the evaluation and management of girls with AGT.
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Affiliation(s)
- Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Yong-Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Republic of Korea.
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Joong Eui Rhee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Republic of Korea
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McAleer IM. Editorial Comment. Urology 2013; 82:1130; discussion 1130-1. [DOI: 10.1016/j.urology.2013.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shnorhavorian M, Hidalgo-Tamola J, Koyle MA, Wessells H, Larison C, Goldin A. Unintentional and sexual abuse-related pediatric female genital trauma: a multiinstitutional study of free-standing pediatric hospitals in the United States. Urology 2012; 80:417-22. [PMID: 22704182 DOI: 10.1016/j.urology.2012.04.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/06/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate a large national database of free-standing pediatric institutions to define the characteristics of patients who have both unintentional and sexual abuse-related pediatric female genital trauma (PFGT), to describe variation in practice across institutions and between trauma and nontrauma hospitals, and to determine factors associated with diagnostic evaluation and surgical repair of PGFT. METHODS We performed a retrospective cohort using the Pediatric Health Information System (PHIS) discharge database with information from 41 freestanding children's hospitals. We identified inpatient and emergency department visits for female patients younger than 18 years of age with International Classification of Diseases, Ninth Revision diagnosis codes for nonobstetric PFGT discharged in the 5-year period between January 1, 2003 and December 31, 2007. RESULTS We identified 5664 patients with PFGT, with 64% having been evaluated in state-designated trauma centers. Although overall only 4.2% (236/5664) underwent a diagnostic evaluation, independent of age, mechanism of injury, associated injuries, and insurance status, patients evaluated in a trauma center were 2.6 times more likely to have a diagnostic evaluation. Patients who underwent a diagnostic evaluation were 18 times more likely to have a surgical repair. Other factors associated with increased odds of diagnostic evaluation included age group and specific mechanisms of injury. CONCLUSION Among institutions in PHIS, diagnostic evaluation and surgical repair is rarely performed and is defined by variability in approach between hospitals--especially between trauma vs nontrauma institutions. This study of PFGT suggests that aggressive diagnostic evaluation in the operating room may be beneficial for this population.
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Sommers MS, Brown KM, Buschur C, Everett JS, Fargo JD, Fisher BS, Hinkle C, Zink TM. Injuries from intimate partner and sexual violence: Significance and classification systems. J Forensic Leg Med 2012; 19:250-63. [PMID: 22687765 DOI: 10.1016/j.jflm.2012.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/05/2012] [Accepted: 02/13/2012] [Indexed: 11/28/2022]
Abstract
UNLABELLED While intimate partner violence (IPV) and sexual violence (SV) are highly associated with injury, the healthcare and legal significance of these injuries is controversial. PURPOSE Herein we propose to explore the significance of injury in IPV and SV and examine the current status of injury classification systems from the perspectives of the healthcare and criminal justice systems. We will review current injury classification systems and suggest a typology of injury that could be tested empirically. FINDINGS Within the published literature, we found that no commonly accepted injury typology exists. While nuanced and controversial issues surround the role of injury detection in the sexual assault forensic examination, enough evidence exists to support the continued pursuance of a scientific approach to injury classification. We propose an injury typology that is measurable, is applicable to the healthcare setting and criminal justice system, and allows us to use uses a matrix approach that includes a severity score, anatomic location, and injury type. We suggest a typology that might be used for further empirical testing on the validity and reliability of IPV and SV injury data. CONCLUSION We recommend that the community of scientists concerned about IPV and SV develop a more rigorous injury classification system that will improve the quality of forensic evidence proffered and decisions made throughout the criminal justice process.
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Affiliation(s)
- Marilyn S Sommers
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104, USA.
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Klaassen Z, Go PH, Mansour EH, Marano MA, Petrone SJ, Houng AP, Chamberlain RS. Pediatric genital burns: a 15-year retrospective analysis of outcomes at a level 1 burn center. J Pediatr Surg 2011; 46:1532-8. [PMID: 21843720 DOI: 10.1016/j.jpedsurg.2011.02.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 01/28/2011] [Accepted: 02/17/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Burns involving the genitalia and perineum are commonly seen in the context of extensive total body surface area (TBSA) burns and rarely as isolated injuries because of protection provided by the thighs and the abdomen. Genital burns usually result in extended hospital stays and are accompanied by severe morbidity and increased mortality. METHODS A retrospective analysis of consecutive pediatric (<18 years) patients with burns involving the genitalia admitted to the Saint Barnabas Medical Center Level 1 Burn Unit from January 1, 1995, to December 31, 2009, was performed. RESULTS One hundred sixty pediatric patients (8.3%) had a genital burn, including 105 patients younger than 5 years (65.6%) and 55 patients between 5 and 18 years (34.4%). Overall mean TBSA was 13.8% ± 16.8%, mean TBSA (genitalia) was 0.84% ± 0.25%, mean length of stay (LOS) was 11.9 ± 11.9 days, and mean burn intensive care unit LOS was 4.9 ± 9.7 days. CONCLUSIONS In patients younger than 5 years, a TBSA burn more than 10% with extensive genitalia involvement is almost always the result of a scald injury. Younger patients (<5 years) are more often the victims of abuse, and prolonged LOS is the norm (>2 weeks). Patients 5 years or older are more often male and usually have a TBSA burn more than 15%.
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Affiliation(s)
- Zachary Klaassen
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ 07039, USA
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Abstract
AIM This study analysed nonsexual male genital injuries in boys with regards to aetiology, age, management and outcome. METHODS Patients were identified from the hospital database (between 1999 and 2009) were analysed retrospectively. RESULTS Seventy-four patients (2-17 years) were identified which included 24 toddlers and small children (2-5 years), 36 school age children (6-12 years) and 14 adolescents (13-17 years). Traumas were related to falls (n=14), kicks (n=11), sport (n=10), toilet seats (n=9), motor vehicles (n=8), bicycle (n=4), outdoor activities (n=4) and others causes (n=14). The leading cause of injuries in (i) toddler and small children was related to toilet seat (n=7) and falls (n=7), (ii) school age children to sport (n=8), kicks (n=7) and falls (n=6), and (iii) adolescents to motorcycle accidents (n=5). There were 45 scrotal and 29 penile injuries ranging from lacerations to contusions. Sixty-eight patients required hospital stay (0.5-36 days, Σ=2.4 days). Follow-up examinations were uneventful, except for one minor wound infection. CONCLUSION Nonsexual traumas to the male external genitalia occur mostly in 6- to 12-year-old boys, with sport accidents, kicks and falls being the major causes. Scrotal and penile lacerations and testicular contusions are the most common injuries. Complications after injuries to the male genitals in children are rare.
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Affiliation(s)
- E E Widni
- Department for Pediatric- and Adolescent Surgery, Medical University of Graz, Graz, Austria
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17
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Abstract
We present the case of a 16-year-old girl who was sexually assaulted with transanal forearm penetration resulting in rectal perforation. She required a sigmoid colostomy that was later reversed. The patient's history and physical examination was complicated by multiple factors: she was intoxicated at the time of presentation as well as during the assault; her presentation fluctuated over time, she was obese, and she carried a psychiatric diagnosis. This case report documents a rare injury caused by sexual assault in the adolescent population and also serves as a platform to discuss the evaluation and management of pediatric victims of sexual assault. We support a collaborative model of care including qualified sexual assault pediatricians, sexual assault nurse (or forensic) examiners, medical specialists, and the criminal justice system. The importance of developing updated sexual assault protocols, ensuring their implementation, and maintaining continuous quality assurance cannot be overemphasized.
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18
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Selective Nonoperative Management of Penetrating Abdominal Injuries in Children. ACTA ACUST UNITED AC 2009; 67:1284-6; discussion 1287. [DOI: 10.1097/ta.0b013e3181bbd932] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gabriel NM, Clayton M, Starling SP. Vaginal laceration as a result of blunt vehicular trauma. J Pediatr Adolesc Gynecol 2009; 22:e166-8. [PMID: 19576824 DOI: 10.1016/j.jpag.2009.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 03/27/2009] [Accepted: 03/30/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sexual abuse often is the primary diagnosis considered when prepubertal girls present with vaginal trauma. Although sexual abuse is very concerning and should remain high in the differential diagnosis, a variety of accidental injuries also can cause genital injury. CASE A 5-year-old girl presented to the emergency department with genital bleeding after a vehicle rolled over her pelvis. She had isolated vaginal lacerations on exam. SUMMARY AND CONCLUSION Extreme pelvic compression is an adequate mechanism of injury in a child presenting with vaginal laceration.
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20
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Affiliation(s)
- Laura J Benjamins
- Department of Pediatrics The University of Texas Medical School, Houston, USA
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21
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22
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Jones JG, Worthington T. Genital and anal injuries requiring surgical repair in females less than 21 years of age. J Pediatr Adolesc Gynecol 2008; 21:207-11. [PMID: 18656075 DOI: 10.1016/j.jpag.2007.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 10/16/2007] [Accepted: 10/17/2007] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE The injuries of sexually abused and assaulted girls seldom require surgical repair, and genital and anal injuries due to other causes appear to require repair uncommonly. We sought to determine the causes of genital and anorectal injuries requiring surgical repair in relation to such variables as injury sites and severity. DESIGN Retrospective study SETTING A large tertiary care children's hospital PARTICIPANTS Forty-four girls less than 21 years of age who required surgical repair of genital injuries between June 1986 and April 2007 were identified. MAIN OUTCOME MEASURES Information collected included the victims' ages, trauma mechanisms, and sites and severity of injuries. RESULTS Injuries requiring repair of the genital and anal areas were uncommon in the 20 year period of this study. Although most injuries were due to straddle and impalement mechanisms, sexual abuse or assault was identified in 25% of the girls. The remaining 11% were victims of motor vehicle accidents. Straddle/impalement injuries involved only the external genitalia, vestibule, perineum, or posterior fourchette of 21 of the 28 girls (76%) with those injuries. The injuries of 9 of the 11 sexually abused/assaulted girls (82%) also involved the hymen, vagina, anus, or rectum. Injuries due to sexual abuse/assault and motor vehicle accidents (MVA) had average severity scores of 2.1 and 2.2, respectively, while straddle injuries had an average severity score of 1.4. (Exact Pearson chi-square P < 0.003.) The ages of the girls were unrelated to the severity of their injuries. CONCLUSIONS Although straddle/impalement was the most commonly found mechanism of genital and anorectal injury requiring surgical repair, sexual abuse or assault was identified in 25% of the girls. Sexual abuse and assault should always be considered and assessed appropriately when such injuries are found. Consultation of a social worker or child abuse specialist may be appropriate, especially when injuries clearly not due to an MVA involve the vagina or anorectum. A suspicion of sexual abuse or assault should be reported to the legally mandated state agency in accordance with the laws of state.
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Affiliation(s)
- Jerry G Jones
- Department of Pediatrics, University of Arkansas College of Medicine, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
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Ciğdem MK, Onen A, Duran H, Oztürk H, Otçu S. The mechanical complications of colostomy in infants and children: analysis of 473 cases of a single center. Pediatr Surg Int 2006; 22:671-6. [PMID: 16838189 DOI: 10.1007/s00383-006-1718-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2006] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to determine the morbidity, mortality and possible risk factors in children who underwent colostomy. A total of 473 children who underwent colostomy in our clinic between 1983 and 2005 were retrospectively reviewed. Of these patients, 278 were boys and 195 were girls. The major indications for colostomy were anorectal malformation (252 patients), Hirschsprung's disease (117), and trauma (66). The patients' age ranged from 1 day to 15 years. Of the 473 patients, 254 (53.6%) were < 1 month of age, 97 (20.5%) were 1-12 months of age, and 122 (25.7%) were > 12 months of age. The side of colostomy was transverse in 341 (72%) patients and sigmoid in 132 (28%). The type of colostomy was loop in 364 (77%) patients and diverting in 109 (23%). Postoperative complication was observed in 80.5% of patients; excoriation (46.5%), prolapse (20.5%), stomal obstruction/stenosis (6.1%), and stomal bleeding (2.1%). A stomal revision was required for 26 (5.5%) patients. Overall, 50 (10.5%) patients died; 37 were related directly to major congenital anomalies, while 13 (2.7%) patients had a colostomy complication. The age of patients who died was < 1 month in 46 (92%) patients. The incidence of morbidity and mortality in children with colostomy is significantly high, particularly in neonates. Prompt colostomy procedure by an experienced hand, prompt stomal care under the supervision of a trained and experienced stomal care giver and early closure of the colostomy may increase the survival of these patients.
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Affiliation(s)
- Murat Kemal Ciğdem
- Department of Pediatric Surgery, Dicle University, 21280 Diyarbakir, Turkey.
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