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The Management of Anorectal Injuries in a Nigerian Paediatric Tertiary Centre
Abstract
Background Anorectal injuries are rare in children. Recently there has been an increasing trend towards primary repair without proximal colostomy. This is a review of our experience with anorectal injuries in children in a paediatric tertiary centre in Nigeria.
Patients and Methods All children 15 years or below managed for anorectal injuries in our institution over a 6 year period have been retrospectively reviewed.
Results There were 9 children. Five were boys and 4 were girls. Their ages ranged from 4 days - 15 years (median 8 years). Four injuries were due to blunt trauma while 5 were due to penetrating trauma. Road Traffic Accidents (RTAs) and gunshot injuries accounted for 3 each, 1was iatrogenic during Caesarian delivery, while fall from height and cow horn injury accounted for 1 each. Rectal bleeding was the commonest presenting symptom. Only 3 children presented to the hospital within 12 hours of injury. Six had rectal injuries (2 were intraperitoneal and 4 extrperitoneal, 2 of which had associated anal injuries). Three had anal injuries without rectal injuries. Associated injuries were to the colon 2, urethra 2, vagina 2, bone fracture 2, spleen 1, urinary bladder 1 and scrotum 1. Intraperitoneal injuries were treated by repair and colostomy. Extraperitoneal injuries were treated by repair and proximal colostomy in 3; and repair without colostomy in 1. Anal injuries were repaired in 3 children without proximal colostomy after exclusion of proximal injuries. Four children had wound infection (3 without colostomy, 1 had colostomy). One child with intraperitoneal rectal injury associated with colonic and splenic injury died of overwhelming sepsis and multiple organ failure. Faecal continence was achieved in 4 children with anal injuries, while 1 child who had proximal colostomy is awaiting colostomy closure.
Conclusion The immediate recognition of anorectal injuries in children is vital to a successful outcome. Though primary repair without proximal colostomy is feasible in selected cases wound complication in this group is high.
Key Words: Anorectal injury, children, colostomy, wound complication.
African Journal of Paediatric Surgery Vol.(1)1 2004: 29-32
Patients and Methods All children 15 years or below managed for anorectal injuries in our institution over a 6 year period have been retrospectively reviewed.
Results There were 9 children. Five were boys and 4 were girls. Their ages ranged from 4 days - 15 years (median 8 years). Four injuries were due to blunt trauma while 5 were due to penetrating trauma. Road Traffic Accidents (RTAs) and gunshot injuries accounted for 3 each, 1was iatrogenic during Caesarian delivery, while fall from height and cow horn injury accounted for 1 each. Rectal bleeding was the commonest presenting symptom. Only 3 children presented to the hospital within 12 hours of injury. Six had rectal injuries (2 were intraperitoneal and 4 extrperitoneal, 2 of which had associated anal injuries). Three had anal injuries without rectal injuries. Associated injuries were to the colon 2, urethra 2, vagina 2, bone fracture 2, spleen 1, urinary bladder 1 and scrotum 1. Intraperitoneal injuries were treated by repair and colostomy. Extraperitoneal injuries were treated by repair and proximal colostomy in 3; and repair without colostomy in 1. Anal injuries were repaired in 3 children without proximal colostomy after exclusion of proximal injuries. Four children had wound infection (3 without colostomy, 1 had colostomy). One child with intraperitoneal rectal injury associated with colonic and splenic injury died of overwhelming sepsis and multiple organ failure. Faecal continence was achieved in 4 children with anal injuries, while 1 child who had proximal colostomy is awaiting colostomy closure.
Conclusion The immediate recognition of anorectal injuries in children is vital to a successful outcome. Though primary repair without proximal colostomy is feasible in selected cases wound complication in this group is high.
Key Words: Anorectal injury, children, colostomy, wound complication.
African Journal of Paediatric Surgery Vol.(1)1 2004: 29-32
