The Management of Perineal Trauma in Children

Abstract

Aims: This study aimed to evaluate the outcome of perineal trauma in children and to a define protocol for their management. Methods: It is a retrospective study of children who presented with perineal injury between August 2012 and December 2020. The patients were classified into three groups: Group-1 included children with perineal and genitourinary injuries; Group-2 included patients with perineal and anorectal injuries; and Group-3 included patients with perineal, genitourinary, and anorectal injuries. All patients underwent primary repair. Those with full-thickness anorectal injury underwent an additional covering colostomy, while urethral disruption was initially managed by a diverting suprapubic cystostomy (SPC). Results: A total of 41 patients were studied. Impalement injury ( n = 11; 27%) and sexual abuse ( n = 11; 27%) were the most common mechanisms of injury. Twenty (49%) patients had anorectal injuries with 10 (24%) each of partial-thickness and full-thickness injury. There were 24 (59%) genital injuries and five (12%) urethral injuries. One patient each developed anal and vaginal stenosis, both were managed with dilatation. One patient developed a rectovaginal fistula repaired surgically at a later date. Conclusion: Perineal injuries with resultant anorectal or genital damage require a careful primary survey. Following stabilization, an examination under anesthesia as a set protocol will help determine the treatment strategy. A colostomy is essential in the acute management of severe anorectal injuries to reduce local complications and preserve continence. Urethral injuries may warrant an initial diverting SPC in selected cases.

Management of Genital, Anal, and Perineal Trauma in Children: 10 Year Experience

“…In a study examining 41 patients in whom sexual injury and impalement injury often play a role in the etiology, the patients were divided into three groups as perineal and genitourinary, perineal and anorectal, and perineal genitourinary and anorectal injuries [11]. We have classified it differently according to the genital injury score, which is more comprehensive.…”

A Rare Case of Anorectal Injury Communicating with the Back in a Child

“…[ 1 ] Manjunath et al ., 2022, in their case series of 41 cases, divided their patients into three groups on the thickness of anorectal injury and the presence of urethral injury. [ 2 ]…”

“…[ 1 ] The management of traumatic injuries to the anus and rectum depends on the severity, involvement of sphincters, extent and level of the anorectal injury, intraperitoneal injuries, and degree of contamination. [ 2 3 ] Since these structures are delicate in children, and hence, their repair can be challenging. We are reporting the case of a female child who presented with a traumatic anorectal injury which was successfully managed in a staged manner.…”