Traumatismes par violences sexuelles: à propos de 8 cas observés chez l’enfant

Abstract

The sexual abuse is increasingly frequent in young children. The lesions are complex with serious psychological consequences, risk pregnancy of and the risk of contamination by HIV. The goal of this work was to report clinical aspects of sexual abuse we observe in children and proposed a guideline. From January 2004 to October 2008, 8 young girls with sexual violence had been treated in paediatric surgery of Teaching Hospital of Treichville. Their age varied from 3 to 12 years; the lesions from the rupture of the hymen to dilapidations of perineum, and rupture of cul-de-sac of Douglas. 1 girl had a closed fracture of the left femur. Surgical operations carried out were: suture of cul-de-sac of Douglas after laparotomy, colostomy, vaginoplasty, perineorraphy, or/and sphincterorraphy. HIV/AIDS prophylaxis was possible in 2 cases. Psychotherapy was made in 2 cases. The post-operative results were satisfactory in the three girls (75%). The aspect of perineum was acceptable, the sphincter of anus was tonic, the fracture of femur was consolidated and the colostomy was closed 43 days after the first operation. The patients were HIV, syphilis and hepatitis negative. The mean follow up was 62 days (2days to 1year). Sexual violence exists in the young children. Female and male may be concern. Perpetrator is well known by the child or parents in about 62,5% of sexual abuse. Psychological effects on the future sexual life of these children are important. The obstetrical future related to cicatricial perineum, is unforeseeable. HIV/AIDS prophylaxis, to be effective, must be done in 48hours. Prevention of pregnancy must also be a priority. The lesions observed in young children are very severe leading to the conclusion that sexual violence in children is a medicosurgical and psychological emergency.