Outcome of Peri-Anal Injury Management in Children and Adolescents

Abstract Background Accidental genital trauma and perineal injury are relatively uncommon in the paediatric population and are often related to accidental falls, motor vehicle crashes and sexual abuse. Blunt perineal trauma causes mechanical compression of the soft tissues against the pelvic bones. Management of perineal injury differs depending on the mechanism of injury and the presence of additional trauma. The severity and extent of injury are often difficult to estimate by only physical examination, and radiological modalities may be insufficient to determine the true extent of damage in severe cases. In such cases, a diagnostic endoscopic examination under anesthesia is useful to fully comprehend the damage. Objectives To evaluate and describe outcome of different perineal trauma mechanisms and management in pediatric patients. Methods Retrospective descriptive analytic study of outcome of perineal injuries management, was conducted on 11 patients aged under 18 years old with perineal injuries due to perineal trauma, admitted to pediatric surgery department or followed up in colo-rectal clinic of pediatric surgery department, Faculty of Medicine, Ain Shams University Hospitals. Results Three patients with isolated genital injury or perineal body injury could be primarily repaired without fecal diversion, one case developed wound dehiscence due to stool contamination so fecal diversion was done. The other seven patients with involvement of ano- rectum underwent fecal diversion from the start, with four cases had their wounds primarily repaired, two cases left to heal by 2ry intention and underwent definitive perineal reconstruction later on, and only one case of impalement that had no any external wounds. Conclusion Perineal injury management should start with resuscitation, thorough examination, proctoscopy, vaginoscopy or cystoscopy could be needed, examination under anesthesia is a gold standard measurement. Patients with isolated genital injuries could be primarily repaired without fecal diversion. Patients with ano-rectal involvement mostly will need fecal diversion, with primary repair of the perineal wounds or leaving it to heal with 2ry intention according to the degree of contamination, time of presentation, degree of ano-rectal involvement. Perineal body reconstruction technique based on the principles of the PSARP operation used in ano-rectal malformations.