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. 2025 Jun 18;41(1):177.
doi: 10.1007/s00383-025-06075-x.

Unusual causes of perineal trauma in paediatric patients: lessons learned from a high-volume colorectal clinic in a low-and-middle-income country

Francesca Palmisani  1   2 , Keitumetse Teko  3 , Catterina Bebington  3   4 , Giulia Brisighelli  3   4
Affiliations

Unusual causes of perineal trauma in paediatric patients: lessons learned from a high-volume colorectal clinic in a low-and-middle-income country

Francesca Palmisani et al. Pediatr Surg Int. .

Abstract

Purpose: In low-and-middle-income countries (LMIC), a non-negligible number of cases of paediatric perineal trauma is observed. Trauma can arise from less conventional mechanisms such as traditional enemas and flame burns, alongside blunt and penetrating injuries. The data on surgical management and long-term outcomes are limited. This study aims to evaluate surgical treatment and continence outcomes post-reconstruction.

Methods: A retrospective review was conducted at Johannesburg's Chris Hani Baragwanath Academic Hospital (2018-2025). Cases of sexual abuse were excluded. Patients were stratified based on whether they required surgical reconstruction. Data analysed included demographics, injury cause, procedures, and long-term continence via the Krickenbeck questionnaire.

Results: Of 20 patients, 10 underwent reconstruction. In the conservative group, 7 (70%) needed a colostomy for sepsis-free recovery. The median age was 3.5 years in the reconstruction group versus 6.6 years in the conservative group (p = 0.039). Traditional enemas caused 60% of injuries in the reconstruction group, while blunt and penetrating trauma was predominant (70%) in the conservative group (p = 0.05). Reconstruction included Swenson pull-through (7), PSARP (2), and perineal body reconstruction (2). The median follow-up was 4 years: 75% of patients achieved continence.

Conclusion: Established anorectal reconstruction techniques are effective for traumatic perineal injuries, providing good cosmetic and continence outcomes.

Keywords: Acquired colorectal conditions; Low-middle income country; Paediatric colorectal surgery; Perineal trauma.

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Conflict of interest statement

Declarations. Conflict of interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Injuries resulting from a traditional enema. Figure 1a illustrates the injuries preoperatively; Fig. 1b illustrates the postoperative result after Swenson Pull-through
Fig. 2
Fig. 2
Injuries resulting from a flame burns. Figure 2a illustrates the injuries preoperatively (complete disruption of the sphincters with scarring and complete stricture of the anus); Fig. 2b illustrates the postoperative result after PSARP
Fig. 3
Fig. 3
Straddle Injuries resulting from fall. Figure 3a illustrates the injuries preoperatively; Fig. 3b illustrates the postoperative result after perineal body repair
See this image and copyright information in PMC

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