29. National Pediatric Surgery Congress and 27. National Congress of The Egyptian Pediatric Surgical Association

Background/Purpose:

The management of perineal trauma in children can be very challenging in 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.

Methods: Thirty two patients with perineal trauma were treated at Tanta university hospital and affiliated hospitals during the period from May 2003 to July 2010. After initial assessment, resuscitation and treatment of any existing life threatening condition, the perineal with trauma was treated either by primary repair of all perineal soft tissue injuries without colostomy (group I, n=16),  primary perineal repair with with covering colostomy (group II, n=11) , or fecal diversion and wound drainage with delayed sphincteric repair if needed (group III, 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 significant skin loss All patients were evaluated as regards to the type of trauma, findings of physical examination, type of management, postoperative  wound infection or disruption, functional (anorectal continence) and cosmetic results.

Results: the ages ranged from 1 to 14 years. Two patients died due to associated head trauma and other concomitant injuries in group III. Significant wound infection occurred in 3 patients (one in each group), partial wound disruption occurred in 2 patients in group I. Normal anorectal continence was reported in 25 (80.6%) of 31 patients who are older than 3 years.

Conclusions: 1. The proposed simple algorithm for management of perineal trauma in children has facilitated decision making in emergency room. 2. Primary repair of the anorectal sphincter and other injured soft tissue with or without covering colostomy is recommended. 3.  Fecal diversion without sphincteric repair should be reserved to cases with significant anorectal lacerations associated with gross contamination.