Surgical aspects of child sexual abuse.
BACKGROUND
The aim of the study was to examine the child sexual abuse cases recognized in a pediatric surgery unit and to highlight the surgical aspects and obstacles that medical professionals face when managing child sexual abuse. A second objective was to analyze the effect of a new legislative system on the legal action taken to protect children.


METHODS
A retrospective study of child sexual abuse cases documented in our institute from 1987 to 2007 was carried out. Data collected included gender, age, complaints, evaluation, and the suspected perpetrator at the time of recognition of abuse. The patients were divided into two groups. Group I included victims between 2 and 8 years of age. Group II consisted of persons between 9 and 25 years of age. The patients were additionally grouped according to the type of surgical presentation and the legislative action taken. The legal action taken to protect the children was analyzed for two eras. Era one was prior to the year 2005. Era two extended from 2005-2007. The legal action taken to protect children in those two different eras was compared.


RESULTS
A total of seventy-eight cases of child sexual abuse were diagnosed out of 54,000 patients, giving an incidence of 0.14 %. Twenty-two (28.2 %) of the cases of child sexual abuse were boys. Three cases (3.9 %) were non Saudi. The perpetrator could not be identified in 21 cases (26.9 %). The perpetrator was related to the family of the child in 42/78 (53.8 %) of cases. The father was involved in 29 (37.2 %) of cases. Fifty-six (71.8 %) cases of child sexual abuse presented as surgical conditions. Dysfunctional elimination syndrome (DES) was the main symptom in 11/78 abused children (14.1 %). Eight (61.5 %) of 13 girls presenting with genital trauma were younger than 8 years of age. Seventeen (22 %) cases presenting either with acute or late posttraumatic stress disorder (PTSD) were older than 7 years of age. Eight patients (10.3 %) were disabled children. Eight families (10.2 %) had a low socioeconomic status. Thirteen cases (16.7 %) were referred to the legal authorities.


CONCLUSIONS
Pediatric surgeons and pediatric urologists should consider child sexual abuse when dealing with patients in whom the signs and symptoms do not fit the original pathology. The main factor that would protect and prevent child sexual abuse would be to establish a program of collaboration between all authorities involved.
Raboei
E H
EH
Department of Pediatric Surgery, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia. enaamraboei@yahoo.fr
D000293:Adolescent; D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data* / Q000628:therapy*; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002675:Child, Preschool; D003625:Data Collection; D019988:Children with Disabilities / Q000706:statistics & numerical data; D005260:Female; D005836:Genitalia, Female / Q000293:injuries* / Q000601:surgery; D006776:Hospitals, Pediatric; D006801:Humans; D007179:Incest / Q000706:statistics & numerical data; D015994:Incidence; D008297:Male; D010808:Physical Examination; D011203:Poverty / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D012742:Sex Offenses / Q000706:statistics & numerical data; D055807:Stalking / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000628:therapy; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D013577:Syndrome; D014555:Urination Disorders / Q000209:etiology / Q000628:therapy