title: Management of child victims of acute sexual assault: Surgical repair and beyond.
abstract: OBJECTIVE
  To evaluate the outcome of definitive repair of anogenital injuries (AGI) in child victims of acute sexual assault.
  
  
  METHODS
  It is a prospective study of emergency care provided to child victims of acute sexual assault at a tertiary care Pediatric Surgical Unit in Maharashtra, India.
  
  
  METHODS
  Out of 25 children, who presented during January 2009-December 2010 with suspected sexual assault, five children (one male and four female, between 4-9 years of age), had incurred major AGI. These children underwent definitive repair and a diverting colostomy. Perineal pull-through was performed in the male child with major avulsion of rectum. One 4-year-old girl with intraperitoneal vaginal injury required exploratory laparotomy in addition.
  
  
  RESULTS
  The postoperative period and follow-up was uneventful in all our patients. Four out of five patients have excellent cosmetic and functional outcome with a follow-up of 2-4 years. Our continence results are 100%.
  
  
  CONCLUSIONS
  Children with acute sexual assault need emergency care. To optimally restore the distorted anatomy, all major AGI in such children should be primarily repaired by an expert, conversant with a child's local genital and perineal anatomy. Along with provision of comprehensive and compassionate medical care, prevention of secondary injuries should be the ultimate goal.
authors.affiliation: Department of Pediatric Surgery, Byramjee Jeejeebhoy Medical College, Pune, Maharashtra, India.
authors.forename: Minakshi
authors.initials: M
authors.lastname: Sham
authors.forename: Dasmit
authors.initials: D
authors.lastname: Singh
authors.forename: Uma
authors.initials: U
authors.lastname: Wankhede
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Wadate
keywords: Anogenital injuries; acute sexual assault; child abuse; definitive surgical repair; emergency management
references.citation: J Trauma. 1974 Mar;14(3):187-96
references.pmid: 4814394
references.citation: J Pediatr Surg. 1996 Sep;31(9):1236-40
references.pmid: 8887092
references.citation: J Pediatr Surg. 1992 Jan;27(1):85-8
references.pmid: 1552453
references.citation: Eur J Pediatr Surg. 2003 Aug;13(4):249-55
references.pmid: 13680494
references.citation: Pediatrics. 2005 Aug;116(2):506-12
references.pmid: 16061610
references.citation: World J Surg. 2003 Aug;27(8):895-900
references.pmid: 12759777
references.citation: Pediatr Surg Int. 2000;16(5-6):388-91
references.pmid: 10955570
references.citation: Am J Surg. 1996 Nov;172(5):575-8; discussion 578-9
references.pmid: 8942566
references.citation: J Pediatr Adolesc Gynecol. 2008 Aug;21(4):207-11
references.pmid: 18656075
references.citation: J Pediatr Adolesc Gynecol. 2011 Apr;24(2):e39-41
references.pmid: 21190877
references.citation: Pediatrics. 1989 Nov;84(5):900-6
references.pmid: 2797984
references.citation: Pediatrics. 2003 Oct;112(4):829-37
references.pmid: 14523174