J. J. Lopez1, L. Kelley-Quon1, A. Kerlek3, M. Luken3, K. McCracken2, R. Thakkar1, B. Nwomeh1 1Nationwide Children’s Hospital,Department Of Pediatric Surgery,Columbus, OHIO, USA 2Nationwide Children’s Hospital,Department Of Pedatric And Adolescent Gynecology,Columbus, OHIO, USA 3Nationwide Children’s Hospital,Center For Family Safety And Healing,Columbus, OHIO, USA
Introduction: Injuries to the perineum, rectum, and vagina carry significant risk for morbidity particularly in the pediatric population. While the frequency of perineal trauma is low, morbidity is high making it critical to understand the mechanisms, management, and outcomes.
Methods: The trauma registry at a Level 1 free-standing pediatric trauma center was queried for patients from 2005 to 2014 diagnosed with perineal trauma. Demographics, hospital outcomes, and procedures were collected.
Results: A cohort of 111 patients with an average age 6.8 years (8 months to 19 years) who sustained trauma to the perineum was identified. The majority were female (n=108, 97.3%) and Caucasian (n=79, 71.2%). Seventy-six falls/straddle injuries, 6 cycle accidents, 2 pedestrians struck, 3 sport injuries, 15 physical/sexual assaults, and 9 other mechanisms (straining and animal incidents). Average length of hospitalization was 1.3 days (standard deviation 0.889). In this cohort, 109 patients (98%) sustained lacerations/abrasions of the rectum and vagina without the presence of hematoma. Fourteen episodes (12.6%) of sexual assault were noted. Ninety-nine patients (89%) underwent exams under anesthesia, within the first 24 hours of admission, and received simple to complex vaginal/perineal/rectal laceration repairs. No patients required surgical diversion. Thirty-two (28.9%) patients received a social work and Child Abuse Team consultation. Four patients (3.6%) were referred to foster care upon discharge while most were discharged home.
Conclusions: Early intervention with a multidisciplinary approach allows for optimal care of pediatric patients with perineal injuries. Future research should target patients at risk for perineal trauma to optimize safety, prevention, and emotional well-being.