Background

Child Sexual Assault (CSA) is not an uncommon but an under-reported crime. Along with social and psychological critical issues, there are multiple challenges faced by the surgical team for the treatment of complex perineal injuries associated with CSA. This study was conducted to find clinical presentation and management of CSA along with its problems and challenges encountered by the pediatric surgical team.

Materials and Methods

This was a retrospective study from 2010 to 2019, conducted in the department of pediatric surgery at a tertiary referral center. All-female patients with a definitive history of sexual assault were included in the study.

Results

Seven patients fulfilled the inclusion criteria and the mean age was 5.3 years. After a primary survey, all patients were taken up for examination under anesthesia (EUA). Three patients were managed by the primary repair of the wound and did well during follow-up. Four patients had grade 4 perineal injury and required stage reconstruction. As a first stage, repair of rectal tear, vaginal tear, and the perineal body reconstruction was done along with diversion colostomy. One patient required redo repair of the perineal body and one had developed a rectovaginal fistula. Three patients completed all stages and they are fully continent.

Conclusion

The spectrum of injuries varies widely in CSA and more chances of high-grade perineal injuries in children due to distinctive local anatomy. EUA is crucial to assess the extent of the injury and to decide the course of management. Meticulous anatomical repair and diversion stoma is the key for successful complex repair and excellent long-term outcomes in terms of continence for the severe grade of perineal injuries.

中文翻译：

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在印度三级医疗转诊中心，儿童性侵犯的管理中的临床表现，治疗和挑战

背景

儿童性侵害（CSA）并不少见，但漏报率很高。除社会和心理方面的关键问题外，外科团队在治疗与CSA相关的会阴部复杂损伤方面也面临着多重挑战。进行这项研究的目的是发现CSA的临床表现和管理方法，以及小儿外科团队遇到的问题和挑战。

材料和方法

这是2010年至2019年在三级转诊中心小儿外科进行的一项回顾性研究。具有明确性侵犯史的全女性患者被纳入研究。

结果

7名患者符合纳入标准，平均年龄为5.3岁。初步调查后，所有患者均接受麻醉（EUA）检查。三名患者接受了伤口的初步修复，并在随访中表现良好。4名患者会阴4级损伤，需要进行分期重建。作为第一阶段，与转移结肠造口术一起进行了直肠撕裂，阴道撕裂和会阴体重建的修复。一名患者需要对会阴体进行重做修复，而一名患者出现了直肠阴道瘘。三名患者完成了所有阶段，他们全是大陆。

结论

在CSA中，伤害的范围差异很大，并且由于特殊的局部解剖结构，儿童发生高度会阴损伤的机会也更多。EUA对于评估伤害程度和决定管理过程至关重要。细致的解剖修复和转移造口是成功进行复杂修复并在严重会阴损伤的节制方面具有出色长期效果的关键。