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Pediatric Surgery International

Published in:

01-11-2012 | Original Article

Penetrating anorectal injuries in Jamaican children

Authors: Michelle V. Vincent, Colin Abel, Newton D. Duncan

Published in: Pediatric Surgery International | Issue 11/2012

Abstract

Purpose

To discuss the presentation, management and outcomes of penetrating anorectal injuries at the Bustamante Hospital for Children.

Methods

A retrospective review over an 11-year period (January 2001–December 2011) was undertaken. The data analysed were extracted from patients’ case notes which were pulled based on the hospital’s admission database.

Results

Over the study period a total of 14 children presented with penetrating anorectal injuries. The medical records for one child were missing. The mean age at presentation was 6 years. Impalement by a metal spike was the mechanism of injury in 12 children, with one case of sexual assault. Three of the children had associated urogenital injuries. Ten rectal injuries were extraperitoneal. Five of the 13 cases (38 %) were managed with a colostomy—average time to closure was 6 months. There was one case of perineal wound infection and dehiscence. There was no mortality.

Conclusion

Selective fecal diversion in the form of a sigmoid loop colostomy is a safe and acceptable management option for children with penetrating anorectal injuries. The perineal wound itself can be closed primarily except in cases of delayed presentation.

Sendia Kim, Bradley L, Cendron M, Puder M (2006) Pediatric anorectal impalement with bladder rupture: case report and review of the literature. J Pediatr Surg 41:e1–e3

Grisoni ER, Hahn E, Marsh E, Volsko et al (2000) Pediatric perineal impalement injuries. J Pediatr Surg 35:702–704PubMedCrossRef

Black T, Pokorny WJ, MaGill CW, Harberg FJ (1982) Anorectal trauma in children. J Pediatr Surg 17:501–504PubMedCrossRef

Beiler HA, Zachariou Z, Daum R (1998) Impalement and anorectal injuries in childhood: a retrospective study of 12 cases. J Pediatr Surg 33:1287–1291PubMedCrossRef

Ameh EA (2000) Anorectal injuries in children. Pediatr Surg Int 16:388–391PubMedCrossRef

Bonnard A, Zamakhshary M, Wales PW (2007) Outcomes and management of rectal injuries in children. Pediatr Surg Int 23:1071–1076PubMedCrossRef

Jones LW, Bass DH (1991) Perineal injuries in children. Br J Surg 78:1105–1107PubMedCrossRef

Bronkhorst MW, Wilde JCH, Hamming JF, Heij HA (2007) Anorectal impalement in a pediatric patient with transanal evisceration of small bowel. J Pediatr Surg 42:e23–e25PubMedCrossRef

Ozturk H, Onen A, Dokucu AI, Otcu S, Yagmur Y, Yucesan S (2003) Management of anorectal injuries in children: an eighteen-year experience. Eur J Pediatr Surg 13:249–255PubMedCrossRef

10.

Grasberger RC, Hirch EF (1983) Rectal trauma: a retrospective analysis and guidelines for therapy. Am J Surg 145:795–799PubMedCrossRef

11.

Scheidler MG, Shultz BL, Schall L et al (2000) Mechanism of blunt perineal injury in female pediatric patients. J Pediatr Surg 35:1317–1319PubMedCrossRef

12.

Bennett DL, Duthie HL (1964) The functional importance of the internal anal sphincter. Br J Surg 51:355–357PubMedCrossRef

13.

Gaston EA (1948) The physiology of fecal continence. Surg Gynecol Obstet 87:280–290PubMed

14.

Delancey JO, Toglia MR, Perucchini D (1997) Internal and external sphincter anatomy as it relates to midline obstetric lacerations. Obstet Gynecol 90:924–927PubMedCrossRef

15.

Lindqvist PG, Jernetz M (2010) A modified surgical approach to women with obstetric anal sphincter tears by separate suturing of external and internal anal sphincter. A modified approach to obstetric anal sphincter injury. BMC Pregnancy childbirth 10:51–56PubMed

16.

Reinberg O, Yazbeck S (1989) Major perineal trauma in children. J Pediatr Surg 24:982–984PubMedCrossRef

17.

Jona JZ (1997) Accidental anorectal impalement in children. Pediatr Emerg Care 13:40–43PubMedCrossRef

18.

Karanikas ID, Kakoulidis DD, Gouvas ZT, Hartley JE, Koundourakis SS (1997) Barium peritonitis: a rare complication of upper gastrointestinal contrast investigation. Postgrad Med 73:297–298CrossRef

19.

Hernanz-Schulman M, Foster C, Maxa R et al (2000) Experimental study of mortality and morbidity of contrast media and standardized fecal dose in the peritoneal cavity. Pediatr Radiol 30:369–378PubMedCrossRef

20.

Leaphart CL, Danko M, Cassidy L et al (2006) An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children: which is better? J Pediatr Surg 41:700–703PubMedCrossRef

21.

Nelken N, Lewis F (1989) The influence of injury severity on complication rates after primary closure or colostomy for penetrating colon trauma. Ann Surg 209:439–447PubMedCrossRef

22.

Burch JM, Feliciano DV, Mattox KL (1989) Colostomy and drainage for civilian rectal injuries: is that all? Ann Surg 209:600–611PubMedCrossRef

23.

Tuggle D, Huber PJ (1984) Management of rectal trauma. Am J Surg 148:806–808PubMedCrossRef

24.

Morris DM, Rayburn D (1991) Loop colostomies are totally diverting in adults. Am J Surg 161:668–671PubMedCrossRef

25.

Renz BM, Feliciano DV, Sherman R (1993) Same admission colostomy closure (SACC) - a new approach to rectal wounds: a prospective study. Ann Surg 218:279–293PubMedCrossRef

26.

Blomquist P, Jiborn H, Zederfeldt B (1985) Effect of diverting colostomy on collagen metabolism in the colonic wall. Am J Surg 149:330–333PubMedCrossRef

27.

Blomquist P, Jiborn H, Zederfeldt B (1985) Effect of diverting colostomy on breaking strength of anastomoses after resection of the left side of the colon: studies in the rat. Am J Surg 149:712–715PubMedCrossRef

28.

Sola JE, Buchman TG, Bender JS (1994) Limited role of barium enema examination preceding colostomy closure in trauma patients. J Trauma 36:245–247PubMedCrossRef

29.

Hashish AA (2011) Perineal trauma in children: a standardized management approach. Ann Pediatr Surg 7:55–60CrossRef

30.

Debeugny P, Bonnevalle M (1988) Injuries of the rectum in children. 79 cases. Chir Pediatr 29:123–135PubMed

Title: Penetrating anorectal injuries in Jamaican children
Authors: Michelle V. Vincent
Colin Abel
Newton D. Duncan
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 11/2012
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-012-3176-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Penetrating anorectal injuries in Jamaican children

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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