Ovarian Cystadenoma in a Trafficked Patient

Abstract

The topic of child sex trafficking is receiving increased attention both in the lay press and in research articles. Recently, a number of physician organizations have issued policy statements calling for the education and involvement of physicians in combating this form of “modern-day slavery.” Primary care and emergency medicine physicians have led these efforts, but a number of these victims may present to surgeons. Surgeons are in a unique position to identify trafficked patients; during the process of undraping, intubation, and surgical preparation, signs of trafficking such as tattoos, scars, dental injuries, and bruising may be evident. In addition, these patients may have specific needs in terms of anesthesia and postoperative care due to substance abuse. Here, we report the case of an 18-year-old girl with a history of sexual exploitation who presents for cystadenoma excision. To our knowledge, this is the first report of a sex-trafficked pediatric patient presenting for surgery.

Confusing Terms

“…Structures and systems that were barriers for her to disclose during the 1.5 years she attempted to seek care from her pediatrician likely further fueled her disadvantaged condition and oppression. Grooming was also evident in this case as she disclosed that her father physically and sexually abused her while taking heroin, as well as encouraging her to exchange sex for money (Titchen et al, 2016). In addition, consequences were evident in this exemplar, including health, social–emotional, and economic.…”

“…An exemplar provides an applicable illustration of the descriptions and characteristics of the concept. Titchen et al (2016) published a case study regarding a Latina adolescent patient referred to adolescent medicine by her pediatrician for left-sided abdominal pain for 1.5 years. According to Titchen et al, the child presented with obesity and multiple tattoos, including expletives and symbols, disclosing her undocumented runaway status and history of sexual debut at the age of 13 years.…”

“…In conversation with the provider, she further disclosed an estimated 150 sexual partners, multiple STIs, and heroin abuse, including several overdose episodes, and a history of suicidal attempts. Titchen et al further described the patient disclosure of “frequent physical and sexual abuse by her father while on drugs, and encouraging exchanging sex for money.” It was reported in the case study that she had discussed a positive relationship with her mother and that she was regularly seen by her pediatrician since the age of 12 years yet never disclosed the extent of her sexual exploitation or drug history until presenting to adolescent medicine (Titchen et al, 2016). During evaluation, her providers noted STI infections, with treatment initiated.…”