Twenty years of experience with perineal injury in children

Bakal, Ünal; Saraç, Mehmet; Tartar, Tugay; Çığşar, Emine Burcu; Kazez, Ahmet

doi:10.1007/s00068-015-0576-y

Cited by 20 publications

(24 citation statements)

References 12 publications

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“…1 Falling from a height is the leading cause of perineal trauma (67% of cases), followed by motor vehicle collision (28%). 5 Obstetric injuries are also a possible cause of perineal trauma in the pediatric population but they are usually classified as a different entity and addressed separately in all the reports that we encountered. 6,7 It is estimated that 5 to 21% of pediatric perineal trauma is secondary to sexual abuse.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 It is estimated that 5 to 21% of pediatric perineal trauma is secondary to sexual abuse. 1,5 However, the true incidence and prevalence is not known and is likely underestimated, since most cases of sexual assault are under-reported by the victims because of the associated stigma. 2 Perineal injuries can be classified according to the genital injury score (GIS) or according to the Sultan's classification (►Fig.…”

Section: Discussionmentioning

confidence: 99%

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A Surgical Technique to Repair Perineal Body Disruption Secondary to Sexual Assault

Brisighelli

Levitt

Wood

et al. 2020

European J Pediatr Surg Rep

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Surgical Technique to Repair Perineal Body Disruption Secondary to Sexual Assault

Brisighelli

Levitt

Wood

et al. 2020

European J Pediatr Surg Rep

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“…If internal injury cannot be ruled out, image- and minimally invasive diagnosis methods such as CT scan, colposcopy, cystoscopy and rectoscopy are reported to be useful to evaluate the damage extension. Diagnostic laparoscopy or laparotomies are usually performed when intraabdominal hemorrhage, organ perforation or any damage proximal of the anal sphincter is identified [19]. …”

Section: Discussionmentioning

confidence: 99%

“…Peritoneal lavage and colostomy after ano-rectoplasty are recommended by some authors to facilitate primary healing process, but the evidence is weak. Primary repair is reported to offer best results in terms of functional as well as cosmetic outcomes while infected injuries or those with repeated disruption are reported to produce permanent changes [19]. Lack of evidence exists about which approach allows best tissue approximation and surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Surgical repair of genital injuries after sexual abuse

Krentel

Devassy

Wilde

et al. 2019

GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW; 8:Doc14

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“…13 In our studies, these organs could clearly be evaluated under anesthesia so we did not need to apply endoscopic procedures.…”

Section: Discussionmentioning

confidence: 99%

External genital injuries in childhood: obey the rules and detect the unseen

Tuncer¹,

Embleton²,

User³

et al. 2018

Int Surg J

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Background: This paper evaluates the patients with external genital organ injuries (EGOI) and the suitability of the Onen’s genital injury scoring (GIS) for the management of such patients.Methods: This is a cross-sectional study. Patients with the complaints of EGOI were retrospectively explored regarding to age, sex, trauma type, hospitalization time, classification of injury type, presence of additional pathologies and treatment methods. After the injury types are classified by using the Onen’s GIS, we investigated the sufficiency of this scoring method for our treatment modalities.Results: A total of 57 patients, 19 females and 38 males, were diagnosed as EGOI. These patients were classified with Grades (G) by using the Onen’s GIS (G1: 42, G2: 7, G3: 5, G4: 2, and G5: 1 patient.). The Grade 5 patient had a colostomy. The external anal sphincters of two patients were repaired to avoid incontinence in the future. The other patients received either medical or non-specific surgical treatments for their injuries. A G3 patient with testicular hematoma had testicular atrophy in the following year. There was no mortality in the present series.Conclusions: The EGOI at childhood ranges from minor derma-abrasion to complete tears of anorectum which requires colostomy. Onen’s GIS ensures better management.

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Twenty years of experience with perineal injury in children

Abstract: The genital injury score is a useful genital trauma scale for predicting anogenital injury severity. Identifying the mechanism and severity of perineal and associated injuries under general anaesthesia may facilitate appropriate classification and management.

Cited by 20 publications

References 12 publications

A Surgical Technique to Repair Perineal Body Disruption Secondary to Sexual Assault

A Surgical Technique to Repair Perineal Body Disruption Secondary to Sexual Assault

Surgical repair of genital injuries after sexual abuse

External genital injuries in childhood: obey the rules and detect the unseen

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