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Mirande MH, Durhman MR, Bethel FB, Smith HF, Mirande RA. Pediatric rectal perforation repaired via endoscopic clipping: An alternative technique. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
The leading cause of death in the pediatric population is trauma, of which pelvic injuries make up a very small percentage. Trauma to the pelvis can result in multiple injuries to the bony pelvis, rectum, bladder, and or the urethra. Although mortality in the pediatric population is typically secondary to associated injuries, pelvic hemorrhage can be a life-threatening event. The management of patients with complex pelvic injuries requires a multidisciplinary approach in order to achieve the best possible outcomes.
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Affiliation(s)
- Amita A Desai
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - Katherine W Gonzalez
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - David Juang
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
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Ashimi A, Amole T, Ugwa E. Reported Sexual Violence among Women and Children Seen at the Gynecological Emergency Unit of a Rural Tertiary Health Facility, Northwest Nigeria. Ann Med Health Sci Res 2015; 5:26-9. [PMID: 25745572 PMCID: PMC4350058 DOI: 10.4103/2141-9248.149780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Various forms of sexual violence including: Coerced marriage or wife inheritance, female genital mutilation, forced exposure to pornography, rape by intimate partner or strangers, unwanted sexual advances, and sexual abuse occurs, especially in vulnerable groups. However, most of these cases are not reported. AIM The aim was to review reported cases in the facility, determine the prevalence and pattern of presentation. SUBJECTS AND METHODS This was a prospective longitudinal study undertaken at the Gynecological Emergency Unit of a Tertiary Health Facility in a rural setting Northwest Nigeria. A study of survivors of alleged sexual violence who presented to the hospital from the September 1, 2011 to August 31, 2013. RESULTS During the study period, there were 24 cases of sexual violence (22 were alleged rape and 2 were others) of 973 gynecological consultations at the emergency unit, giving a prevalence of 3% (24/973) for sexual violence and 2.3% (22/973) for alleged rape. Majority 91.7% (22/24) of the cases were children < 16 years; 45.8% (11/24) had no formal education while 33.3% (8/24) hawked homemade drinks and snacks. The assailants were known in 83.3% (20/24) of the cases; of which 45.8% (11/24) were neighbors, 29.2% (7/24) were buyers of snacks and drinks while 8.3% (2/24) were family members. CONCLUSION The prevalence of reported sexual violence in this facility was low with the majority of the survivors being children and nonstranger assailants', mostly neighbors.
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Affiliation(s)
- Ao Ashimi
- Department of Obstetrics and Gynecology, Federal Medical Centre Birnin Kudu, Jigawa State, Nigeria
| | - Tg Amole
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ea Ugwa
- Department of Obstetrics and Gynecology, Federal Medical Centre Birnin Kudu, Jigawa State, Nigeria
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Akakpo-Numado GK, Boume MA, Mihluedo-Agbolan KA, Simlawo K, Adabra K, Tekou H. Perforation of large and small intestines by impalement in a 13-year-old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
BACKGROUND Complex injuries involving the anus and rectum are uncommon in children. We sought to examine long-term fecal continence following repair of these injuries. METHODS We conducted a retrospective review using our trauma registry from 2003 to 2012 of children with traumatic injuries to the anus or rectum at a level I pediatric trauma center. Patients with an injury requiring surgical repair that involved the anal sphincters and/or rectum were selected for a detailed review. RESULTS Twenty-one patients (21/13,149 activations, 0.2%) who had an injury to the anus (n=9), rectum (n=8), or destructive injury to both the anus and rectum (n=4) were identified. Eleven (52%) patients were male, and the median age at time of injury was 9 (range 1-14) years. Penetrating trauma accounted for 48% of injuries. Three (14%) patients had accompanying injury to the urinary tract, and 6 (60%) females had vaginal injuries. All patients with an injury involving the rectum and destructive anal injuries were managed with fecal diversion. No patient with an isolated anal injury underwent fecal diversion. Four (19%) patients developed wound infections. The majority (90%) of patients were continent at last follow-up. One patient who sustained a gunshot injury to the pelvis with sacral nerve involvement is incontinent, but remains artificially clean on an intense bowel management program with enemas, and one patient with a destructive crush injury still has a colostomy. CONCLUSIONS With anatomic reconstruction of the anal sphincter mechanism, most patients with traumatic anorectal injuries will experience long-term fecal continence. Follow-up is needed as occasionally these patients, specifically those with nerve or crush injury, may require a formal bowel management program.
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Sham M, Singh D, Wankhede U, Wadate A. Management of child victims of acute sexual assault: Surgical repair and beyond. J Indian Assoc Pediatr Surg 2013; 18:105-11. [PMID: 24019641 PMCID: PMC3760308 DOI: 10.4103/0971-9261.116043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: To evaluate the outcome of definitive repair of anogenital injuries (AGI) in child victims of acute sexual assault. Settings and Design: It is a prospective study of emergency care provided to child victims of acute sexual assault at a tertiary care Pediatric Surgical Unit in Maharashtra, India. Material and Methods: Out of 25 children, who presented during January 2009-December 2010 with suspected sexual assault, five children (one male and four female, between 4-9 years of age), had incurred major AGI. These children underwent definitive repair and a diverting colostomy. Perineal pull-through was performed in the male child with major avulsion of rectum. One 4-year-old girl with intraperitoneal vaginal injury required exploratory laparotomy in addition. Results: The postoperative period and follow-up was uneventful in all our patients. Four out of five patients have excellent cosmetic and functional outcome with a follow-up of 2-4 years. Our continence results are 100%. Conclusion: Children with acute sexual assault need emergency care. To optimally restore the distorted anatomy, all major AGI in such children should be primarily repaired by an expert, conversant with a child’s local genital and perineal anatomy. Along with provision of comprehensive and compassionate medical care, prevention of secondary injuries should be the ultimate goal.
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Affiliation(s)
- Minakshi Sham
- Department of Pediatric Surgery, Byramjee Jeejeebhoy Medical College, Pune, Maharashtra, India
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Abstract
PURPOSE To discuss the presentation, management and outcomes of penetrating anorectal injuries at the Bustamante Hospital for Children. METHODS A retrospective review over an 11-year period (January 2001-December 2011) was undertaken. The data analysed were extracted from patients' case notes which were pulled based on the hospital's admission database. RESULTS Over the study period a total of 14 children presented with penetrating anorectal injuries. The medical records for one child were missing. The mean age at presentation was 6 years. Impalement by a metal spike was the mechanism of injury in 12 children, with one case of sexual assault. Three of the children had associated urogenital injuries. Ten rectal injuries were extraperitoneal. Five of the 13 cases (38 %) were managed with a colostomy-average time to closure was 6 months. There was one case of perineal wound infection and dehiscence. There was no mortality. CONCLUSION Selective fecal diversion in the form of a sigmoid loop colostomy is a safe and acceptable management option for children with penetrating anorectal injuries. The perineal wound itself can be closed primarily except in cases of delayed presentation.
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Gümüş M, Böyük A, Kapan M, Onder A, Taskesen F, Aliosmanoğlu İ, Tüfek A, Aldemir M. Unusual extraperitoneal rectal injuries: a retrospective study. Eur J Trauma Emerg Surg 2011; 38:295-9. [DOI: 10.1007/s00068-011-0163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 10/22/2011] [Indexed: 11/29/2022]
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Bonnard A, Zamakhshary M, Wales PW. Outcomes and management of rectal injuries in children. Pediatr Surg Int 2007; 23:1071-6. [PMID: 17710420 DOI: 10.1007/s00383-007-1996-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2007] [Indexed: 11/28/2022]
Abstract
In the pediatric population, rectal injuries usually occur as a result of motor vehicle collisions. There has been an increased interest in selective diversion of rectal injuries in adults and increased utilization of laparoscopy both as a diagnostic and therapeutic adjunct. The aim of the study was to review our institutional experience with rectal injuries to determine if there was a subset of patients who could be managed with selective diversion. The medical records of children admitted with a rectal injury to Hospital for Sick Children, Toronto, over the last 20 years (1984-2004) were retrospectively reviewed. Data abstraction included patient demographics, mechanism of injury, injury severity score, associated injuries, presenting symptoms, methods of diagnosis, treatment and resultant complications. Nine patients with rectal injuries were identified. The average injury severity score (ISS) was 19.3. Two patients with penetrating injuries underwent laparoscopy. Laparoscopy was able to define the intraperitoneal extension of injuries and guide the colostomy. Primary repair without a diverting colostomy was performed in 3 patients (2 intraperitoneal and 1 extraperitoneal injury) without complications. Based on the limited sample size, one should avoid making any definitive recommendations but, it appears, primary repair without fecal diversion can be performed safely in select children in spite of a longer time to surgery. Laparoscopy may be used for the immediate management of the penetrating trauma patient to rule out intraperitoneal extension, repair a perforation and guide the colostomy if necessary.
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Affiliation(s)
- Arnaud Bonnard
- Division of General Surgery, Hospital for Sick Children, Room 1526, 555 University Avenue, Toronto, ON, Canada M5G 1X8
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Elder DE. Interpretation of anogenital findings in the living child: Implications for the paediatric forensic autopsy. J Forensic Leg Med 2007; 14:482-8. [DOI: 10.1016/j.jflm.2007.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Revised: 01/04/2007] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
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Leaphart CL, Danko M, Cassidy L, Gaines B, Hackam DJ. An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children: which is better? J Pediatr Surg 2006; 41:700-3; discussion 700-3. [PMID: 16567179 DOI: 10.1016/j.jpedsurg.2005.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current dogma suggests that the diagnosis of rectal injury can be made after physical examination and proctoscopy (PR). However, anecdotal evidence suggests that these modalities lack specificity when applied to children and that computed tomography (CT) scanning may be superior. A direct comparison between CT scanning and PR has not been performed. We therefore sought to compare CT with PR in the diagnosis of rectal injury by analyzing our large institutional experience. METHODS To assess institutional outcome, the charts of all children younger than 18 years admitted to our level I trauma center (1999-2004) were prospectively collected and retrospectively assessed. Demographics, diagnostic accuracy (PR vs CT), and outcome (length of stay, days in the intensive care unit [ICU], Injury Severity Score, and missed injury) were assessed. RESULTS There were 24 injuries (63% boys, 71% blunt, 100% survival), and diagnostic modality included the following: PR, 37.5%; CT, 37.5%; laparotomy alone, 8%. Length of stay (PR 5.7 +/- 6.2 vs CT 13.7 +/- 22.2, NS) were similar between groups. Of the missed rectal injuries, 66% of patients undergoing PR had missed injuries that were ultimately detected by CT whereas 33% of the patients undergoing CT scan had a missed injury. CONCLUSION CT is at least as accurate as PR in diagnosing pediatric rectal injury. Consideration of early scanning as opposed to PR may improve diagnosis and outcome in these patients.
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Affiliation(s)
- Cynthia L Leaphart
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Ohno Y, Furui J, Kanematsu T. Posterior sagittal anorectoplasty for the management of blunt anorectovaginal injury: case report. THE JOURNAL OF TRAUMA 2005; 58:863-6. [PMID: 15824672 DOI: 10.1097/01.ta.0000136156.93994.d3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Yasuharu Ohno
- Division of Pediatric Surgery, Department of Surgery, Nagasaki University Graduate School of Medical Sciences, Japan.
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Abstract
Injuries to the gastrointestinal tract account for 1% to 15% of intraabdominal injuries in children. Most hollow visceral injuries occur following some form of blunt trauma and motor vehicle accidents remain the most common mechanism of injury. The diagnosis of blunt intestinal injury is difficult and often delayed. Current imaging modalities are imprecise and contribute to delay. Delay is associated with morbidity and mortality in both children and adults, but the length of delay remains controversial. The purpose of this review is to examine the current diagnosis and management of hollow visceral injury in children.
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Affiliation(s)
- Jennifer L Bruny
- Department of Surgery, The University of Colorado School of Medicine, The Children's Hospital, Denver, CO 80218, USA
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Ameh EA. Anal injury and fissure-in-ano from sexual abuse in children. ANNALS OF TROPICAL PAEDIATRICS 2001; 21:273-5. [PMID: 11579868 DOI: 10.1080/02724930120077871] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Ano-rectal injuries in children are generally uncommon, and those caused by sexual abuse are rarely reported in our environment. This is a report of two children aged 5 and 12 years who sustained anal injuries following anal sexual abuse. Both presented late with fissure-in-ano and were managed conservatively. Though fissure-in-ano is not uncommon in children, it might be necessary to exclude sexual abuse and undertake appropriate evaluation and treatment. The child must be protected from further abuse.
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Affiliation(s)
- E A Ameh
- Paediatric Surgery Unit, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
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