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. 2022 Jan-Feb;27(1):65-70.
doi: 10.4103/jiaps.JIAPS_322_20. Epub 2022 Jan 11.

The Management of Perineal Trauma in Children

Darshan A Manjunath  1   2 , Veerabhadra Radhakrishna  2 , Deepti Vepakomma  2
Affiliations

The Management of Perineal Trauma in Children

Darshan A Manjunath et al. J Indian Assoc Pediatr Surg. 2022 Jan-Feb.

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.

Keywords: Anorectal injuries; colostomy; examination under anesthesia; pediatric perineal trauma; sexual abuse; urogenital injuries.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Institute protocol for managing perineal trauma
Figure 2
Figure 2
STROBE flow diagram
Figure 3
Figure 3
A 5-year-old female presented with a history of sexual assault. Examination under anesthesia revealed a laceration of the posterior fourchette (a) with extension along the posterior wall of the vagina (b). She underwent primary repair. The wound healed well (c) without any complication
See this image and copyright information in PMC

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