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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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Irumba C, Baragaine J, Obore S, Mwanje H, Nteziyaremye J. An intricate vagina penetrating injury with a 22 cm cassava stick in situ for 6 months: a case report. J Med Case Rep 2024; 18:30. [PMID: 38267997 PMCID: PMC10809435 DOI: 10.1186/s13256-023-04339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Trauma remains one of the major causes of morbidity and mortality and a threat to attainment of sustainable development goal 11. Genital urinary trauma is reported in about 10% of patients presenting with trauma worldwide, and in about 6.6% of patients in Sub-Saharan Africa. If not careful enough, one may miss the foreign body in the vagina and this may be associated with morbidity, and although rare, mortality. CASE PRESENTATION We report a case of a 7-year-old Black Ugandan that had suffered vagina trauma 6 months prior to presentation at our facility and presented with chronic vagina pus discharge for 6 months. Prior examinations had failed to recognize the foreign body and so did the two abdominal pelvic ultrasound scans. During examination under anesthesia, we were able to locate the cassava stick that had caused penetrating vagina injury and we were able to dislodge it. It was a blunt cassava stick with length of 22 cm and diameter of 2 cm. Although it had gone through the peritoneal cavity, we did not do a laparotomy. CONCLUSION This case emphasizes the need for a thorough vaginal exam including the need to do it under anesthesia with good lighting even when ultrasound scan findings are normal. It presents an opportunity for one to manage penetrating peritoneal injury without a laparotomy in highly selected cases. Gynecologists should be keen as well to rule out child molestation.
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Affiliation(s)
- Charles Irumba
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Urogynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Justus Baragaine
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Urogynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Susan Obore
- Department of Urogynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Haruna Mwanje
- Department of Urogynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Julius Nteziyaremye
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda.
- Department of Obstetrics and Gynaecology, Mbale Regional Referral Hospital, Mbale, Uganda.
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Bloomfield V, Iseyemi A, Kives S. Clinical Review: Prepubertal Bleeding. J Pediatr Adolesc Gynecol 2023; 36:435-441. [PMID: 37301426 DOI: 10.1016/j.jpag.2023.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/15/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Prepubertal bleeding is a common presentation in the pediatric office and can be distressing for patients and families. A comprehensive approach to diagnosis and management allows clinicians to identify patients at risk for worrisome pathology and arrange timely care. OBJECTIVE We aimed to review the key features of clinical history, physical exam, and diagnostic workup of a child presenting with prepubertal bleeding. We reviewed potential pathologies requiring urgent investigations and management, such as precocious puberty and malignancy, as well as more common etiologies, including foreign bodies and vulvovaginitis. CONCLUSION Clinicians should approach each patient with the goal of excluding diagnoses that require urgent interventions. A thoughtful clinical history and physical exam can inform appropriate investigations to optimize patient care.
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Affiliation(s)
- Valerie Bloomfield
- Department of Pediatric and Adolescent Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Abigail Iseyemi
- Department of Obstetrics and Gynecology, London Health Sciences Center - Victoria Hospital, London, Ontario, Canada
| | - Sari Kives
- Department of Pediatric and Adolescent Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada.
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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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5
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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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6
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McLaughlin CJ, Martin KL. Radiologic Imaging Does Not Add Value for Female Pediatric Patients with Isolated Blunt Straddle Mechanisms. J Pediatr Adolesc Gynecol 2022; 35:541-545. [PMID: 35691505 DOI: 10.1016/j.jpag.2022.06.002] [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: 03/21/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVES The purpose of this study was to characterize the utility of radiologic imaging and examination under anesthesia in female pediatric patients with isolated blunt straddle injuries. DESIGN Retrospective review. SETTING Single health care system with a children's hospital and level 1 pediatric trauma center. PARTICIPANTS Female patients aged 1-17 years with blunt straddle injuries from 2006 to 2018. INTERVENTIONS None. MAIN OUTCOME MEASURES Radiologic imaging performed, number of patients requiring exam under anesthesia (EUA), number of injuries not identified in patients who did not undergo EUA. RESULTS The study cohort included 83 patients. Of these, 11 (13%) had imaging performed. Thirty-four patients were managed as outpatients, 28 were discharged from the emergency department without need for intervention, and 49 patients were admitted. Of these, 48 (98%) went to the operating room for exam EUA. No occult injuries were identified on radiologic studies. Imaging was not associated with need for EUA. No missed injuries occurred in children who were not imaged. Two patients who were imaged returned for EUA following evolution of symptoms. CONCLUSION Radiologic imaging did not add diagnostic value for female pediatric patients with blunt straddle injuries. These data emphasize the importance of EUA with repair and advocates for minimization of radiologic imaging in this patient group.
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Affiliation(s)
| | - Kathryn L Martin
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, Pennsylvania
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7
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Cizek SM, Tyson N. Pediatric and Adolescent Gynecologic Emergencies. Obstet Gynecol Clin North Am 2022; 49:521-536. [PMID: 36122983 DOI: 10.1016/j.ogc.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnosis of gynecologic emergencies in the pediatric and adolescent population requires a high index of suspicion to avoid delayed or incorrect diagnoses. This article aims to dispel common misunderstandings and aid with diagnosis and management of 3 common pediatric and adolescent gynecologic emergencies: adnexal torsion, vulvovaginal lacerations, and nonsexually acquired genital ulcers.
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Affiliation(s)
- Stephanie M Cizek
- Pediatric and Adolescent Gynecology, Department of OB/GYN, Stanford University School of Medicine, Center for Academic Medicine, MC 5317, 453 Quarry Road, Palo Alto, CA 94304, USA.
| | - Nichole Tyson
- Pediatric and Adolescent Gynecology, Department of OB/GYN, Stanford University School of Medicine, Center for Academic Medicine, MC 5317, 453 Quarry Road, Palo Alto, CA 94304, USA
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8
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Pediatric vulvo-vaginal lacerations in a community-based population. Am J Emerg Med 2021; 55:194-195. [PMID: 34154862 DOI: 10.1016/j.ajem.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 11/21/2022] Open
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Al-Dossary IM, AlZahrani AS, Elshafei H, Al-Buainain HM. Successful Management of Perineal Injury without Colostomy in a Pediatric Patient: A Case Report. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2021; 9:190-194. [PMID: 34084111 PMCID: PMC8152376 DOI: 10.4103/sjmms.sjmms_242_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/14/2020] [Accepted: 04/06/2021] [Indexed: 11/06/2022]
Abstract
Perineal trauma in children are rare, but they can be life-threatening and surgically challenging conditions in the absence of a standardized therapeutic approach. Colostomy remains important and plays an essential role in minimizing the frequency of perineal wound infections but has known complications. Here, we describe a case of a 7-year-old boy who was a victim of a road traffic accident polytrauma and sustained severe perineal injury. The patient was managed primarily without stoma creation and achieved complete wound healing and continence. This case highlights that selection of primary repair without colostomy must be meticulous and individualized.
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Affiliation(s)
- Ibrahim Mohammed Al-Dossary
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Anwar Saeed AlZahrani
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Hossam Elshafei
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Hussah Mohammed Al-Buainain
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Nabavizadeh B, Namiri NK, Hakam N, Li KD, Amend GM, Breyer BN. Playground Equipment-related Genital Injuries in Children: An Analysis of United States Emergency Departments Visits, 2010-2019. Urology 2021; 152:84-90. [PMID: 33775786 DOI: 10.1016/j.urology.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/05/2021] [Accepted: 03/14/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the demographics, epidemiology, and common mechanisms associated with playground equipment-related genital injuries in children. METHODS We examined the National Electronic Injury Surveillance System database to obtain playground-related genital injuries sustained in children ≤17 years from 2010 to 2019. Demographics of the patients and injury characteristics were analyzed using sample weights to produce national estimates. RESULTS During the study period, an estimated 27,738 (95% confidence interval 18,602-36,874) emergency department visits with an average annual incidence of 3.8 (95% confidence interval 2.5-5) per 100,000 United States population ≤17 years were reported. The mean age was 6.6 (standard error 0.152) years with most injuries occurring in pre-school children (48.1%) and females (81.1%). Over ½ of genital injuries (55.2%) were associated with climbing apparatus. This was followed by slides (10.7%), swings (9%), and seesaws (4.8%). Most genital injuries occurred at public (41.4%) and school settings (36.3%). Straddling and/or falling was the most common mechanism leading to genital injuries (84.4%). The incidence of injuries remained constant during the 10-year study period (change = + 2.6%; r2 = 0.121, P = .326). Monthly variations in the number of injuries existed with peak injuries in April-May, and September-October. CONCLUSION Despite current safety standards, genital injuries arising from playground equipment have remained stable since 2010. By defining common devices, mechanisms, and conditions associated with genital injuries, this study may help guide efforts aimed at the prevention of such injuries in various locations.
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Affiliation(s)
- Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nikan K Namiri
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
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11
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Fan SM, Grigorian A, Chaudhry HH, Allen A, Sun B, Jasperse N, Albertson S, Nahmias J. Female pediatric and adolescent genitalia trauma: a retrospective analysis of the National Trauma Data Bank. Pediatr Surg Int 2020; 36:1235-1241. [PMID: 32851470 PMCID: PMC7449526 DOI: 10.1007/s00383-020-04736-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Pediatric genitalia injury represents 0.6% of all pediatric trauma. It is crucial for providers to understand whether pediatric patients are at risk for violent mechanisms, such as rape, assault, or other abuse. Therefore, we sought to perform a large database analysis of pediatric and adolescent female genitalia trauma, comparing mechanisms of injury (i.e., sexual abuse) and need for operative intervention between adolescent and pediatric cohorts. METHODS The National Trauma Data Bank was queried (years 2007-2015) for female patients ≤ 16 years old with external genitalia (vaginal or vulvar) trauma. Two groups were compared: pediatrics (< 12 years old) and adolescents (12-16 years old). RESULTS Out of 303,992 female patients, 3206 (1.1%) were identified to have genitalia trauma with the majority being pediatric patients (92.1%) and with injury to the vagina (62.6%). Pediatric patients with vaginal injury were less likely to be victims of rape (4.1% vs. 17.3%, p < 0.001) and assault (2.1% vs. 7.2%, p < 0.001) but more likely to be victims of other abuse (9.5% vs. 3.4%, p = 0.003). More of the adolescent patients with vaginal trauma required repair (58.7% vs. 43.2%, p < 0.001). Pediatric patients with injury to the vulva were less likely to be victims of rape (0.7% vs. 2.8%, p = 0.01) and motor vehicle accidents (4.2% vs. 11.0%, p < 0.001). CONCLUSION Genitalia trauma occurs in 1.1% of pediatric and adolescent trauma cases with the vagina being more commonly injured compared to the vulva. Adolescent patients with vaginal injuries were more likely to be victims of rape and assault and required repair more often, while those with vulvar injuries were more likely due to motor vehicle accidents. Health care providers must be aware of these at-risk populations and the differences between them to identify female victims of violence and provide resources to assist with recovery.
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Affiliation(s)
- Shannon M. Fan
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Haris H. Chaudhry
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Angela Allen
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Beatrice Sun
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Nathan Jasperse
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Spencer Albertson
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
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12
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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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Goldberg L, Sauer MV, Hutchinson-Colas J. High Dive Platform Jump Results in Perineal Injury to College Athlete. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Leah Goldberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mark V. Sauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Juana Hutchinson-Colas
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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14
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Cheng AY, Cooley AS, Sulton CD. Vaginal Laceration in an Adolescent Girl Presenting With Abdominal Pain. Clin Pediatr (Phila) 2019; 58:1547-1549. [PMID: 31179729 DOI: 10.1177/0009922819854694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amy Y Cheng
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.,Emory University, Atlanta, GA, USA
| | - Anthony S Cooley
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.,Emory University, Atlanta, GA, USA
| | - Carmen D Sulton
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.,Emory University, Atlanta, GA, USA
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15
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Bentivegna K, Durante A, Livingston N, Hunter AA. Child Sexual Abuse identified in Emergency Departments Using ICD-9-CM, 2011 to 2014. J Emerg Med 2019; 56:719-726. [PMID: 31023633 DOI: 10.1016/j.jemermed.2019.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Child sexual abuse (CSA) is poorly identified due to its hidden nature and difficulty surrounding disclosure. Surveillance using emergency department (ED) data may identify victims and provide information on their demographic profile. OBJECTIVES Study aims were to calculate the prevalence of visits assigned an explicit or suggestive medical diagnosis code (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]) for CSA and compare the demographic profile of ED visits by coding type. METHODS This study examined ED data for children < 10 years of age in Connecticut from 2011 to 2014. Cases involving CSA were identified using explicit and suggestive ICD-9-CM codes and age qualifiers previously established in the literature, and compared across visit characteristics (age, race/ethnicity, sex, and primary insurance payer, and town group). RESULTS ICD-9-CM codes for explicit CSA were identified in 110 ED visits, or 1.7 per 10,000 total ED visits. Inclusion of ICD-9-CM codes for suggestive CSA identified an additional 630 visits (9.7 per 10,000 visits). Suggestive codes identified proportionally more visits of younger (50% vs. 38%) and male (35% vs. 22%) children, compared with the explicit code (p < 0.05). CONCLUSIONS This study demonstrates one method for identifying CSA cases, which has the potential to increase surveillance of victims in the ED. Results imply that explicit codes alone may overlook most cases, whereas use of suggestive codes may identify additional cases, and proportionally more young and male victims. As the health consequences of CSA are severe, innovative forms of surveillance must be explored to detect a higher number of cases and improve the clinical care of patients.
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Affiliation(s)
- Kathryn Bentivegna
- Department of Community Medicine and Healthcare, University of Connecticut, Farmington, Connecticut
| | - Amanda Durante
- Department of Community Medicine and Healthcare, University of Connecticut, Farmington, Connecticut
| | - Nina Livingston
- Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Amy A Hunter
- Department of Community Medicine and Healthcare, University of Connecticut, Farmington, Connecticut; Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut; Injury Prevention Center, Connecticut Children's Medical Center, Hartford, Connecticut
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Alsyouf M, Stokes P, Smith J, Amasyali A, Chamberlin D. Traumatic Penile Pseudoaneurysm After Straddle Injury Presenting With Life Threatening Anemia: A Unique Case and a Diagnostic Challenge. Urology 2018; 125:210-212. [PMID: 30471369 DOI: 10.1016/j.urology.2018.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/19/2022]
Abstract
Partial urethral disruption after blunt perineal trauma can be initially managed with urethral catheterization. Lower urinary tract symptoms after catheter removal should raise suspicion for urethral stricture and requires further investigation. Lesser known complications require high index of suspicion to prevent life threatening sequelae. In this report, we describe a case of blunt perineal trauma and partial urethral disruption in a pediatric patient presenting with refractory anemia due to a penile artery pseudoaneurysm. We discuss an unusual presentation, challenging diagnosis and management of this rare condition.
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Affiliation(s)
- Muhannad Alsyouf
- Department of Pediatric Urology, Loma Linda University Health, Loma Linda, CA.
| | - Phillip Stokes
- Department of Pediatric Urology, Loma Linda University Health, Loma Linda, CA
| | - Jason Smith
- Department of Interventional Radiology, Loma Linda University Health, Loma Linda, CA
| | - Akin Amasyali
- Department of Pediatric Urology, Loma Linda University Health, Loma Linda, CA
| | - David Chamberlin
- Department of Pediatric Urology, Loma Linda University Health, Loma Linda, CA
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Dowlut-McElroy T, Higgins J, Williams KB, Strickland JL. Patterns of Treatment of Accidental Genital Trauma in Girls. J Pediatr Adolesc Gynecol 2018; 31:19-22. [PMID: 28782658 DOI: 10.1016/j.jpag.2017.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 07/24/2017] [Accepted: 07/31/2017] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To evaluate the characteristics of girls with accidental genital trauma (AGT) who can be managed in the emergency department (ED) vs the operating suite (OS). DESIGN Retrospective cohort. SETTING ED at a children's hospital in a metropolitan area. PARTICIPANTS Girls aged 0-18 years with AGT. INTERVENTIONS AND MAIN OUTCOME MEASURES Factors associated with need for evaluation and repair of AGT in the OS. RESULTS A total of 359 girls were included in the analysis. The mean age was 6 ± 3 years. Most girls presented with pain and bleeding, 321/359 (89%). Straddle injury was the most common mechanism, 258/355 (73%). The most commonly injured site was the labia, 225/358 (63%) and the most common type of injury was laceration, 308/357 (86%). Factors significantly associated with treatment in the OS included older age, transfer from another institution, penetrating injuries, injuries involving the hymen/vagina/urethra/anus, and injuries larger than 3 cm in size. The odds of requiring general anesthesia in the OS were 5.5 times higher for injuries larger than 3 cm (95% confidence interval, 2.8-10.9; P < .0001) and 4.1 times greater if the patient was transferred from another facility (95% confidence interval, 1.3-13.3; P < .02). CONCLUSION Most AGT can be managed expectantly. Penetrating injuries, injuries to the hymen/vagina/urethra/anus, and injuries with a maximal size of 3 cm should be considered as indications for management in the OS. With adequate procedural sedation, most girls with minor injuries as a result of AGT can undergo a thorough examination and repair of AGT in the ED.
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Affiliation(s)
- Tazim Dowlut-McElroy
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Section of Gynecological Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri.
| | - Jeanette Higgins
- Section of Gynecological Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Karen B Williams
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Julie L Strickland
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Section of Gynecological Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Sogut O, Boleken ME, Cevik M, Yavuz G. Severe Blunt Perineal Trauma in Children: A Retrospective Analysis of 28 Patients. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The current study was designed to determine the common mechanisms of blunt perineal trauma (BPI) and associated injuries in paediatric patient. The initial management and outcome concerning such injuries are discussed. Materials and methods The hospital records of 28 paediatric patients who were treated surgically between April 2004 and November 2010 because of BPI were reviewed retrospectively. The initial clinical examination under conscious sedation (EUCS) in each patient was performed by both an experienced emergency physician and a paediatric surgeon to obtain a complete physical examination. Results Among the 28 paediatric patients, twenty-two girls and six boys, aged 2 to 12 years experienced BPI. Fall onto a rough surface was the main cause for BPI in 21 patients (75%) and the rest had a motor vehicle-pedestrian crash. Five patients had concomitant anal or rectal injuries. There were concomitant urinary tract injuries in eight patients of whom three had combined lacerations or contusions of the perineum and disruption of the posterior urethra. There was concomitant complete rupture of proximal urethra from bladder in one patient. The remaining 4 patients with urinary tract injuries suffered from periurethral lacerations. The fifteen patients without anorectal or urethral injuries had concomitant vaginal or vulvar lacerations. Conclusion All paediatric patients who sustained severe BPI should be checked for multi-system trauma and those undergone routine EUCS to evaluate the extent of concomitant injuries should pay particular attention to the anorectal and urogenital tracts. Primary repair of such injuries is often recommended as the initial treatment of choice.
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Affiliation(s)
- O Sogut
- Harran University School of Medicine, Department of Paediatric Surgery, Sanliurfa, Turkey
| | - ME Boleken
- Harran University School of Medicine, Department of Paediatric Surgery, Sanliurfa, Turkey
| | - M Cevik
- Harran University School of Medicine, Department of Paediatric Surgery, Sanliurfa, Turkey
| | - G Yavuz
- Harran University School of Medicine, Department of Paediatric Surgery, Sanliurfa, Turkey
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Surgical Repair of an Impalement Genital Injury from an Inline Skating Accident in a 7-Year-Old Prepubertal Girl: A Case Report. J Pediatr Adolesc Gynecol 2017; 30:e11-e13. [PMID: 27614287 DOI: 10.1016/j.jpag.2016.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND In girls who present with vaginal trauma, sexual abuse is often the primary diagnosis. The differential diagnosis must include patterns and the mechanism of injury that differentiate accidental injuries from inflicted trauma. CASE A 7-year-old prepubertal girl presented to the emergency department with genital bleeding after a serious accidental impaling injury from inline skating. After rapid abduction of the legs and a fall onto the blade of an inline skate this child incurred an impaling genital injury consistent with an accidental mechanism. The dramatic genital injuries when repaired healed with almost imperceptible residual evidence of previous trauma. SUMMARY AND CONCLUSION To our knowledge, this case report represents the first in the medical literature of an impaling vaginal trauma from an inline skate and describes its clinical and surgical management.
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Gupta D, Yadav DK, Panda SS, Panda M, Bagga D, Acharya SK, Anand N, Naredi BK. Transanal impalement of double J steel bar with colonic and jejunal injury: A unique pediatric case report. J Nat Sci Biol Med 2015; 6:217-9. [PMID: 25810666 PMCID: PMC4367041 DOI: 10.4103/0976-9668.149186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pediatric transanal impalement injuries are relatively uncommon and most are attributed to accidental fall on offending objects, sexual assault or blunt trauma. There may be difficulty in recognizing or properly treating such injuries because their severity may not be reflected externally. Evaluation of suspected rectal impalement injury involves careful history and physical examination and proper investigation. There are very few reports on pediatric perianal impalement with associated visceral injuries. We report a case of assault transanal impalement injury associated with mesenteric tear and jejunal perforation leading to devitalization of proximal jejunum in a 2 year male child and relevant literatures were reviewed. To the best of our knowledge, such dual proximal and distal gastrointestinal injury in such a small child has not been reported in any of the English literature so far.
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Affiliation(s)
- Divya Gupta
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shasanka Shekhar Panda
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Meely Panda
- Department of Community Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Deepak Bagga
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Samir Kant Acharya
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Nischal Anand
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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[Practical guide to the examination and interpretation of genital lesions of minor female victims of sexual assault]. ACTA ACUST UNITED AC 2014; 42:849-55. [PMID: 25458807 DOI: 10.1016/j.gyobfe.2014.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 09/24/2014] [Indexed: 11/22/2022]
Abstract
Through a comprehensive review of the literature on sexual assault, the authors propose to clarify the different stages of the exam and help the practitioner to the forensic interpretation of lesions. The authors describe the basic principles that make consensus in how to interview victims in order to increase the reliability of the information collected. The various medical data that must be collected allowing to guide diagnosis (urogenital symptoms, sexual behaviour disorder) or facilitate the interpretation of lesions (age of puberty, use of tampons…) are specified as well as the different positions of examination and their association to other complementary techniques (Foley catheter, colposcopy, toluidine blue). The authors present a simple decision tree that can help the practitioner to interpret the laceration of the hymen. They detail the description and forensic interpretation of all genital lesions that may be encountered as a result of sexual assault, and the pitfalls to avoid. Finally, two main problems in the interpretation of lesions are described, the absence of injury after penetration and the accidental genital lesions.
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22
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Francis JC, Banaszek TN, Dietrich JE. Use of the Lumitex MD Lightmat® Surgical Illuminator for pediatric genital trauma cases: a retrospective case series. J Pediatr Adolesc Gynecol 2014; 27:e109-11. [PMID: 24581677 DOI: 10.1016/j.jpag.2013.08.005] [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: 06/10/2013] [Revised: 08/08/2013] [Accepted: 08/12/2013] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVES To review the literature regarding repair of pediatric female genital trauma. To review our experience with the use of a lighted retractor at the time of repair of genital trauma in an operating room setting. STUDY DESIGN Retrospective case series. SETTING Texas Children's Hospital. PARTICIPANTS Patients with genital trauma requiring repair in an operating room setting where the Lumitex MD Lightmat Surgical Illuminator (LM) was utilized. INTERVENTIONS Use of the LM in pediatric gynecology patients. RESULTS Of the 16 cases where the LM lighted retractor was utilized, 12 were found to be performed secondary to genital trauma, resulting from straddle injury or coital trauma. Four patients were identified as having either congenital reproductive tract anomalies or foreign body. Patients ranged in age from 1-21 years with a mean age of 9 ± 4.91 years at the time of their vaginal repair. The mean operative time was 82 ± 47 minutes, with cases ranging from 37-182 minutes, with a median blood loss of 7 mL and an average hospital stay of 1.2 days. There were no surgical complications. CONCLUSION Neurosurgeons and otolaryngologists have been optimizing safe visualization of small areas during surgery for years with the use of the LM. In cases of pediatric deep genital trauma, the LM can be used safely for easy visualization, allowing for direct visualization in cases of deep genital trauma.
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Affiliation(s)
- J C Francis
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Baylor College of Medicine, Houston, TX; Texas Children's Hospital, Houston, TX.
| | - T N Banaszek
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Baylor College of Medicine, Houston, TX
| | - J E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Baylor College of Medicine, Houston, TX; Texas Children's Hospital, Houston, TX
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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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Hertweck P, Yoost J. Common problems in pediatric and adolescent gynecology. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Berkenbaum C, Balu L, Sauvat F, Montbrun A, Harper L. Severe vaginal laceration in a 5-year-old girl caused by sudden hydro-distention. J Pediatr Adolesc Gynecol 2013; 26:e131-2. [PMID: 24001435 DOI: 10.1016/j.jpag.2013.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/08/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Severe vaginal trauma in young girls is uncommon. We describe a 5-year-old girl who presented a vaginal laceration following sudden hydro-distention. CASE A 5-year-old girl was transferred to our institution for vaginal trauma with severe bleeding. Her brother had directed the nozzle of a functioning garden hose against her vulva. She presented pain and persistent vaginal bleeding without external genital lesions. Surgical exploration revealed a laceration of the right vaginal wall. The vagina was sutured and the bleeding stopped. SUMMARY AND CONCLUSION This case illustrates a rare mechanism of severe vaginal laceration, in a young girl, by hydro-distention. Though there are often no external lesions the internal lesions can be severe causing significant bleeding. Certainly in these cases aggressive diagnostic evaluation is necessary.
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Affiliation(s)
- C Berkenbaum
- Department of Pediatrics, Centre Hospitalier Universitaire de La Réunion, Site Felix Guyon, Reunion Island, France
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Casey JT, Bjurlin MA, Cheng EY. Pediatric genital injury: an analysis of the National Electronic Injury Surveillance System. Urology 2013; 82:1125-30. [PMID: 23953603 DOI: 10.1016/j.urology.2013.05.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 04/30/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe the characteristics of pediatric genital injuries presenting to United States emergency departments (EDs). METHODS A retrospective cohort study utilizing the U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) from 1991-2010 to evaluate pediatric genital injuries was performed. RESULTS Pediatric genital injuries represented 0.6% of all pediatric injuries with the incidence of injuries rising through the period studied, 1991-2010. The mean age at injury was 7.1 years old and was distributed 56.6% girls and 43.4% boys. A total of 43.3% had lacerations and 42.2% had contusions/abrasions. The majority of injuries occurred at home (65.9%), and the majority of patients (94.7%) were treated and released from the hospital. The most common consumer products associated with pediatric genital trauma were: bicycles (14.7% of all pediatric genital injuries), bathtubs (5.8%), daywear (5.6%), monkey bars (5.4%), and toilets (4.0%). CONCLUSION Although pediatric genital injuries represent a small proportion of overall injuries presenting to the emergency department, genital injuries continue to rise despite public health measures targeted to decrease childhood injury. Our results can be used to guide further prevention strategies for pediatric genital injury.
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Affiliation(s)
- Jessica T Casey
- Department of Urology, Northwestern University, Chicago, IL.
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Abstract
PURPOSE To discuss the presentation, management and outcomes of penetrating anorectal injuries at the Bustamante Hospital for Children. METHODS A retrospective review over an 11-year period (January 2001-December 2011) was undertaken. The data analysed were extracted from patients' case notes which were pulled based on the hospital's admission database. RESULTS Over the study period a total of 14 children presented with penetrating anorectal injuries. The medical records for one child were missing. The mean age at presentation was 6 years. Impalement by a metal spike was the mechanism of injury in 12 children, with one case of sexual assault. Three of the children had associated urogenital injuries. Ten rectal injuries were extraperitoneal. Five of the 13 cases (38 %) were managed with a colostomy-average time to closure was 6 months. There was one case of perineal wound infection and dehiscence. There was no mortality. CONCLUSION Selective fecal diversion in the form of a sigmoid loop colostomy is a safe and acceptable management option for children with penetrating anorectal injuries. The perineal wound itself can be closed primarily except in cases of delayed presentation.
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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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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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30
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Abstract
Straddle injuries are common in children. At the end of this case presentation, you should be able to describe the approach to the evaluation and treatment of a straddle injury, list indications for gynecologic consultation and/or sedation, plan disposition, and discuss pitfalls to avoid in evaluating patients with straddle injuries.
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Abstract
A large number of conditions have been mistaken for abuse. Differentiating accidental injuries from inflicted injuries is important in the management of injured children. In this work, the authors describe two cases of accidental perineal-vaginal injury in children. In case 1, a 4-year-old girl suffered a vaginal tear caused by violent stretching during play; in case 2, a 3-year-old girl had minor lacerations of labia minora and majora. The intervention of a multi-specialist team including a forensic pathologist and forensic psychiatrist was the key factor in being able to exclude abuse by third parties in the described cases. This leads to the appropriate recommendations to be adopted in the forensic medicine setting.
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Affiliation(s)
- Claudia Liuzzi
- Section of Legal Medicine, University of Bari, Pizza Giulio Cesare, 11, 70124 Bari, Italy.
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Affiliation(s)
- Laura J Benjamins
- Department of Pediatrics The University of Texas Medical School, Houston, USA
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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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Elder DE. Interpretation of anogenital findings in the living child: Implications for the paediatric forensic autopsy. J Forensic Leg Med 2007; 14:482-8. [DOI: 10.1016/j.jflm.2007.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Revised: 01/04/2007] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
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Bronkhorst MW, Wilde JCH, Hamming JF, Heij HA. Anorectal impalement in a pediatric patient with transanal evisceration of small bowel. J Pediatr Surg 2007; 42:E23-5. [PMID: 17848228 DOI: 10.1016/j.jpedsurg.2007.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rectal injuries in the pediatric population are most often attributed to accidental falls on offending objects, sexual abuse, or blunt trauma. Anorectal impalement is a rare injury, and as a result, specific knowledge or experience on the treatment of this type of injury in children is sparse. The extent of injury is often difficult to assess. Mostly, therapeutical decisions are based on general knowledge in adults. We present a case of accidental anorectal impalement in a child by a fall on the handle of a toilet brush. The handle caused an anterior rupture of the intraperitoneal part of the rectum with subsequent transanal evisceration of several loops of small bowel.
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Affiliation(s)
- Maarten W Bronkhorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Onen A, Oztürk H, Yayla M, Basuguy E, Gedik S. Genital trauma in children: Classification and management. Urology 2005; 65:986-90. [PMID: 15882738 DOI: 10.1016/j.urology.2005.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 12/20/2004] [Accepted: 01/11/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the severity and, accordingly, the treatment of genital trauma in a pediatric population. METHODS A total of 116 children with genital trauma and anorectal injury were retrospectively reviewed. The severity of trauma was graded according to the genital injury score (GIS), which we developed as a genital trauma scoring system. RESULTS The median age was 8 years. Of the 116 children, 80 were girls and 36 were boys. The etiology of the trauma was traffic road accident (53 patients), fall, sexual abuse, and gunshot wound. Sixty-one patients had additional organ injuries. The GIS was I for 25 children, II for 19, III for 32, IV for 23, and V for 17. In addition to the primary repair, colostomy was performed in 22 patients. The most frequent postoperative complication was wound infection. The postoperative complication rate was significantly greater in patients with an injury severity score greater than 15, severe contamination, prolonged delay (longer than 8 hours), and a GIS of IV or V. CONCLUSIONS The clarification of the mechanism and severity of the genital injury and associated organ injuries under general anesthesia may help in the appropriate classification. Primary repair should be the standard approach in genital trauma patients with a GIS of IV or less. Those with a GIS of V associated with severe contamination and prolonged delay require colostomy for improved outcome.
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Affiliation(s)
- Abdurrahman Onen
- Department of Pediatric Surgery, Dicle University School of Medicine, Diyarbakir, Turkey.
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Ohno Y, Furui J, Kanematsu T. Posterior sagittal anorectoplasty for the management of blunt anorectovaginal injury: case report. THE JOURNAL OF TRAUMA 2005; 58:863-6. [PMID: 15824672 DOI: 10.1097/01.ta.0000136156.93994.d3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Yasuharu Ohno
- Division of Pediatric Surgery, Department of Surgery, Nagasaki University Graduate School of Medical Sciences, Japan.
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Boos SC, Rosas AJ, Boyle C, McCann J. Anogenital injuries in child pedestrians run over by low-speed motor vehicles: four cases with findings that mimic child sexual abuse. Pediatrics 2003; 112:e77-84. [PMID: 12837911 DOI: 10.1542/peds.112.1.e77] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Differentiating between child sexual abuse and nonintentional causes of anogenital injury can be challenging, and a misdiagnosis can have a profound impact on the child and family. This case series documents an important nonintentional mechanism of anogenital injury that mimics the physical findings of child sexual abuse. METHODS Four children were examined after being run over by a slow-moving motor vehicle. In each case, the wheel of the vehicle passed longitudinally over the child's torso. RESULTS Two children had perianal lacerations, and 2 had hymenal lacerations. One child with hymen injuries was followed for 4 weeks and developed findings identical to those seen in healed sexual abuse. CONCLUSIONS Children run over by motor vehicles should be evaluated for anogenital injury. If such injury is suspected, it should be fully delineated and documented with colposcopy and follow-up examination. Although the possibility of sexual abuse must be considered, awareness of the occurrence of anogenital injuries in children run over by motor vehicles may prevent the misdiagnosis of acute sexual abuse in children. Conversely, children presenting for evaluation of acute or past sexual abuse should be questioned as to whether they were ever run over by a motor vehicle.
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Affiliation(s)
- Stephen C Boos
- Department of Pediatrics, Armed Forces Center for Child Protection, National Naval Medical Center, Bethesda, Maryland, USA
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