Perineal trauma in children: a standardized management approach

Abstract

Background/purpose The management of perineal trauma in children is very challenging in the absence of a well-defined institutional management protocol. The purpose of this study was to evaluate the result of implementing a standardized therapeutic approach to perineal trauma in children in our institution.
Patients and methods This is a prospective study on the management of perineal trauma in children, according to a predefined protocol. Thirty-four patients with perineal trauma were treated at the Tanta University Hospital and affiliated hospitals during the period May 2003–July 2010. Two patients died of associated head trauma and other concomitant injuries. After initial assessment, resuscitation, and treatment of any existing life threatening condition, the patients were treated either by primary repair of all perineal soft tissue injuries without colostomy (group 1, n=16), primary perineal repair with covering colostomy (group 2, n=11), or fecal diversion and wound drainage with delayed sphincter repair if needed (group 3, n=5). Each patient was assigned to a particular management depending on the presence or absence of full-thickness anorectal injuries, anorectal lacerations, degree of wound contamination, and/or significant skin loss. All patients were evaluated with regard to the type of trauma, physical findings, management, postoperative wound infection or disruption, postoperative functional outcome, and cosmetic results.
Results The ages ranged from 2 to 14 years. Significant wound infection occurred in three patients (one in each group), moderate-to-mild wound infection occurred in another four patients, partial wound disruption occurred in two patients in group 1. Urethral stricture occurred in two patients, who were treated by repeated dilatation. Vaginal stenosis developed in one patient. Anorectal continence was noted in 25 (80.6%) of 31 patients who were older than 3 years during the last follow-up visit.
Conclusion (i) The proposed simple algorithm for the management of perineal trauma in children has facilitated decision making in the emergency room. (ii) Primary repair of the anorectal sphincter and other injured soft tissue with or without covering colostomy is recommended. (iii) Fecal diversion without sphincter repair should be reserved to cases with significant anorectal lacerations associated with gross contamination.

Keywords: children, colostomy, perineal trauma, primary repair