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Rahnavardi M, Shahali S, Montazeri A, Ahmadi F. Health care providers' responses to sexually abused children and adolescents: a systematic review. BMC Health Serv Res 2022; 22:441. [PMID: 35379242 PMCID: PMC8981665 DOI: 10.1186/s12913-022-07814-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Sexual abuse of children and adolescents is a significant health concern worldwide. Appropriate and timely health services for victims can prevent severe and long-term consequences. This study identified and categorized diagnostic and treatment services needed for sexually abused children and adolescents. Methods Several databases, including MEDLINE, Web of Science, Scopus, Science Direct, ProQuest, and Google Scholar, were searched to retrieve studies on the topic and clinical guidelines in English covering the literature from 2010 to 2020 using search terms. Primary studies and guidelines were reviewed to identify treatment strategies and medical interventions related to sexually abused children and adolescents. Results Twenty-one studies and guidelines were selected and analyzed narratively. The quality of evidence was relatively good. We identified that effective health care systems for sexually abused children include the following: interview and obtain medical history, physical and anogenital examination, collecting forensic and DNA evidence, documenting all the findings, prevention and termination of pregnancy, diagnostic tests, prophylaxis for HIV and other STIs, vaccinations, and psychological intervention. Conclusions This review provides up-to-date evidence about adequate health care services for children and adolescent victims of sexual abuse. We conclude that recent studies have focused more on prophylaxis against HIV and other STIs, studies on vaccinating against HPV for victims are still limited, and future research in this area is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07814-9.
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Affiliation(s)
- Mona Rahnavardi
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Shadab Shahali
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Ali Montazeri
- Health Metrics Research Center, Institute for Health Sciences Research, ACECR, Tehran, Iran.,Faculty of Humanity Sciences, University of Science &Culture, Tehran, Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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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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Hegde S, Bawa M, Kanojia RP, Mahajan JK, Menon P, Samujh R, Rao KLN. Pediatric Trauma: Management and Lessons Learned. J Indian Assoc Pediatr Surg 2020; 25:142-146. [PMID: 32581440 PMCID: PMC7302457 DOI: 10.4103/jiaps.jiaps_35_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/19/2019] [Accepted: 08/03/2019] [Indexed: 11/05/2022] Open
Abstract
Aim: The aim is to prospectively study 125 trauma patients admitted in the pediatric surgery ward in our institute. Materials and Methods: Pediatric patients admitted in the ward after initial resuscitation in the triage room were included. Isolated neurosurgical and orthopedic injuries were excluded. X-ray cervical spine, hip, and chest and a focused assessment with sonography in trauma ultrasound were done for all patients. Computed tomography of the abdomen or chest was done where relevant. Injury profile and surgical intervention when needed were analyzed. Results: Road traffic accidents and fall from height caused 73.6% of the injuries. School-going children were most commonly affected (60.8%). Distinctive injuries were noted such as abdominal wall hernias and delayed bladder perforation. All solid organ injury irrespective of grade treated conservatively. Forty percent of the children required surgical intervention. Five patients after laparotomy were found to have surgical conditions unrelated to trauma, whereas another 14 required delayed surgery. Five patients had injuries secondary to sexual abuse. All except two patients were discharged in a satisfactory condition and are doing well in the follow-up. Conclusion: In spite of extensive injuries and the need for multiple surgeries, children with trauma have a good prognosis. Close observation during admission and also in follow-up are essential, as many patients may require delayed surgery ≥1 week from injury.
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Affiliation(s)
- Shalini Hegde
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Monika Bawa
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi P Kanojia
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jai K Mahajan
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prema Menon
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K L N Rao
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Torres-de la Roche LA, Krentel H, Devassy R, de Wilde MS, Leicher L, De Wilde RL. Surgical repair of genital injuries after sexual abuse. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2019; 8:Doc14. [PMID: 31728263 PMCID: PMC6838733 DOI: 10.3205/iprs000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Genital injuries occur in half of cases of sexual assault through digital or penile penetration as well as the use of objects. Women aged >45 years are more likely to have physical injury and anogenital lesions, transmission of STI and HIV. This review focuses on the evidence about surgical reconstruction of the pelvic floor anatomy of adolescents and adult women sexually assaulted during adolescence or adulthood. Method: A systematic literature search was performed in PubMed and Orbis plus for articles published in English and German from June 2008 to June 2018. The literature search was performed in October 2018 by topic combining the following Medical Subject Headings: genital trauma, genital injuries, sexual assault, rape, surgical repair, treatment. Results: 34 records of descriptive studies were identified and 16 full-text articles were included in the present review. Due to the limited number of articles retrieved, articles were not excluded based on methodological design. Superficial genital lesions are common and usually left untreated. For deep vaginal or anal lacerations, intraperitoneal bleeding is usually assessed by means of and additional CT scan or diagnostic colposcopy, cystoscopy, rectoscopy and laparoscopy. Complete reconstruction of the injured is done after. To prevent rectovaginal fistula and uncomplicated primary wound healing a temporary colostomy can be performed. Conclusion: Although most of genital injuries due to sexual assault do not require any major surgical intervention, there is a lack of good quality evidence regarding the best diagnostic and surgical approach to restore deep lesions of genital organs as well lack evidence on contributors to poor wound healing. Therefore, clinical protocols that standardize examination as well as surgical management are encouraged to be developed.
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Affiliation(s)
| | - Harald Krentel
- Clinic for Obstetrics and Gynecology. St. Anna Hospital, Herne, Germany
| | - Rajesh Devassy
- Dubai London Clinic and Specialty Hospital, Dubai, United Arab Emirates
| | - Maya Sophie de Wilde
- University Hospital for Gynecology, Pius Hospital, Carl von Ossietzky University, Oldenburg, Germany
| | - Lasse Leicher
- University Hospital for Gynecology, Pius Hospital, Carl von Ossietzky University, Oldenburg, Germany
| | - Rudy Leon De Wilde
- University Hospital for Gynecology, Pius Hospital, Carl von Ossietzky University, Oldenburg, Germany
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Abraham M, Kondis J, Merritt DF. Case Series: Vaginal Rupture Injuries after Sexual Assault in Children and Adolescents. J Pediatr Adolesc Gynecol 2016; 29:e49-52. [PMID: 26746636 DOI: 10.1016/j.jpag.2015.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/05/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Vaginal rupture after sexual assault is a rare but life-threatening occurrence requiring prompt recognition and treatment. Herein, we describe four such cases in children. Our purposes are to increase clinicians' awareness of the physical trauma that a sexual abuse victim can suffer and increase recognition that these victims require immediate trauma services. CASES Each patient had obvious hymenal and vaginal lacerations with a vaginal apical rupture injury and secondary acute blood loss. None of the four victims sustained infectious sequelae. SUMMARY AND CONCLUSION Providers should have a low threshold for managing sexual abuse victims as trauma cases when they have obvious hymenal and vaginal lacerations and genital bleeding, proceeding expeditiously to examination using general anesthesia when appropriate.
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Affiliation(s)
- Margaret Abraham
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri.
| | - Jamie Kondis
- Child Abuse Pediatrics, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Diane F Merritt
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
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Abstract
Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability.
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Affiliation(s)
- Jacob Stephenson
- UC Davis Health System, 2221 Stockton Boulevard, Cypress Building #3107, Sacramento, CA 95817.
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Mukwege D, Alumeti D, Himpens J, Cadière GB. Treatment of rape-induced urogenital and lower gastrointestinal lesions among girls aged 5 years or younger. Int J Gynaecol Obstet 2016; 132:292-6. [PMID: 26797200 DOI: 10.1016/j.ijgo.2015.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/13/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate outcomes after treatment of rape-induced urogenital and lower gastrointestinal lesions among young girls. METHODS In a retrospective study, data were assessed from girls aged 5 years or younger who were treated for sexual-assault-related injuries at the General Referral Hospital, Panzi, Bukavu, Democratic Republic of Congo, between 2004 and 2014. Data were obtained from review of charts, records of the mother's impressions and physical examinations, and photographic evidence. Elective surgery had been reserved for patients experiencing fecal and/or urinary incontinence. RESULTS Overall, 205 girls aged 5 years or younger presented with rape injuries: 162 (79.1%) had only mucocutaneous lesions, 22 (10.7%) had musculocutaneous lesions, and 21 (10.2%) had musculocutaneous lesions complicated by fecal and/or urinary incontinence. Among the 21 girls who underwent perineal surgery, two with fecal and urinary incontinence and perforation of the peritoneum of Douglas pouch were additionally treated by laparoscopy. Among 16 patients with fecal incontinence, the continence score had improved significantly at 10.4 months after surgery (P<0.001). Concomitant urinary incontinence subsided for four of five patients but persisted for one who had a gunshot wound to the vagina. Cosmetic outcome was normal in 19 cases. CONCLUSION For rape survivors aged 5 years or younger, a treatment strategy by which surgery is reserved for incontinent patients provided good cosmetic and functional outcomes.
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Affiliation(s)
- Denis Mukwege
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo
| | - Desiré Alumeti
- Pediatric Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo
| | - Jacques Himpens
- Gastrointestinal Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - Guy-Bernard Cadière
- Gastrointestinal Surgery, Saint-Pierre University Hospital, Brussels, Belgium.
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