Ano-rectal trauma in children

Abstract

Ano-rectal trauma is associated with significant physical and emotional morbidity. Except for an occasional straddle injury, child abuse or deviate sexual activity account for most rectal injuries in children. Because the perineum is the source of excretions, it is frequently the target of the emotionally disturbed parent or caretaker, particularly during the toilet training period. During 1979 and 1980, 617 patients were treated for possible rape at our city-county hospital. One hundred and forty-seven (23.8%) were less than 16 yr old. One third alleged anal trauma. Eleven had significant perineal injuries and 4 were taken to the operating room for repair of rectal injuries. A 15-yr-old female sustained a 1-cm rectovaginal tear. A 10-yr-old female sustained a vaginal laceration with a tear through the external anal sphincter. A 5-mo-old male sustained a deep perineal laceration extending into the peritoneal cavity with disruption of the levator mechanism and severe ano-rectal tears. A 7-yr-old female had a 1-cm anterior ano-rectal tear. Cases are presented from our hospital files to illustrate the spectrum of rectal injuries and their treatment. Injuries have varied from simple anal laceration and perineal contusions to destruction of the rectum and formation of a recto-vesical fistula with a coat hanger. Similarly, treatment has varied from local wound care to diverting colostomy and secondary rectal reconstruction with an endorectal pull-through procedure. The pediatric surgeon must be prepared to handle the results of such acts of abuse and to aid in prevention by reporting possible abuse victims before they or their siblings present with other serious injuries. Ano-rectal trauma is associated with significant physical and emotional morbidity. Except for an occasional straddle injury, child abuse or deviate sexual activity account for most rectal injuries in children. Because the perineum is the source of excretions, it is frequently the target of the emotionally disturbed parent or caretaker, particularly during the toilet training period. During 1979 and 1980, 617 patients were treated for possible rape at our city-county hospital. One hundred and forty-seven (23.8%) were less than 16 yr old. One third alleged anal trauma. Eleven had significant perineal injuries and 4 were taken to the operating room for repair of rectal injuries. A 15-yr-old female sustained a 1-cm rectovaginal tear. A 10-yr-old female sustained a vaginal laceration with a tear through the external anal sphincter. A 5-mo-old male sustained a deep perineal laceration extending into the peritoneal cavity with disruption of the levator mechanism and severe ano-rectal tears. A 7-yr-old female had a 1-cm anterior ano-rectal tear. Cases are presented from our hospital files to illustrate the spectrum of rectal injuries and their treatment. Injuries have varied from simple anal laceration and perineal contusions to destruction of the rectum and formation of a recto-vesical fistula with a coat hanger. Similarly, treatment has varied from local wound care to diverting colostomy and secondary rectal reconstruction with an endorectal pull-through procedure. The pediatric surgeon must be prepared to handle the results of such acts of abuse and to aid in prevention by reporting possible abuse victims before they or their siblings present with other serious injuries.