title: Treatment of rape-induced urogenital and lower gastrointestinal lesions among girls aged 5 years or younger.
abstract: OBJECTIVE
  To evaluate outcomes after treatment of rape-induced urogenital and lower gastrointestinal lesions among young girls.
  
  
  METHODS
  In a retrospective study, data were assessed from girls aged 5 years or younger who were treated for sexual-assault-related injuries at the General Referral Hospital, Panzi, Bukavu, Democratic Republic of Congo, between 2004 and 2014. Data were obtained from review of charts, records of the mother's impressions and physical examinations, and photographic evidence. Elective surgery had been reserved for patients experiencing fecal and/or urinary incontinence.
  
  
  RESULTS
  Overall, 205 girls aged 5 years or younger presented with rape injuries: 162 (79.1%) had only mucocutaneous lesions, 22 (10.7%) had musculocutaneous lesions, and 21 (10.2%) had musculocutaneous lesions complicated by fecal and/or urinary incontinence. Among the 21 girls who underwent perineal surgery, two with fecal and urinary incontinence and perforation of the peritoneum of Douglas pouch were additionally treated by laparoscopy. Among 16 patients with fecal incontinence, the continence score had improved significantly at 10.4 months after surgery (P<0.001). Concomitant urinary incontinence subsided for four of five patients but persisted for one who had a gunshot wound to the vagina. Cosmetic outcome was normal in 19 cases.
  
  
  CONCLUSIONS
  For rape survivors aged 5 years or younger, a treatment strategy by which surgery is reserved for incontinent patients provided good cosmetic and functional outcomes.
authors.affiliation: Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.
authors.forename: Denis
authors.initials: D
authors.lastname: Mukwege
authors.affiliation: Pediatric Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.
authors.forename: Desiré
authors.initials: D
authors.lastname: Alumeti
authors.affiliation: Gastrointestinal Surgery, Saint-Pierre University Hospital, Brussels, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Himpens
authors.affiliation: Gastrointestinal Surgery, Saint-Pierre University Hospital, Brussels, Belgium. Electronic address: guy-bernard_cadiere@stpierre-bru.be.
authors.forename: Guy-Bernard
authors.initials: GB
authors.lastname: Cadière
mesh_terms: D001003:Anal Canal / Q000293:injuries*; D002675:Child, Preschool; D015023:Democratic Republic of the Congo; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D011902:Rape; D012007:Rectum / Q000293:injuries*; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014549:Urinary Incontinence / Q000209:etiology; D014621:Vagina / Q000293:injuries*; D014950:Wounds, Penetrating / Q000601:surgery*
keywords: Africa; Anorectal trauma; Assault; Child abuse; Perineal trauma; Rape; Trauma score