PEDIATRIC MALE RECTAL AND GENITAL TRAUMA - ACCIDENTAL AND NONACCIDENTAL INJURIES

Objective: To characterize accidental pediatric rectal/genital trauma in males and compare these physical findings to a cohort of boys evalu ated for sexual abuse. Design: Retrospective chart review. Setting: Te rtiary pediatric trauma center/sexual abuse clinic. Participants: Male patients evaluated in the emergency department for rectal/genital tra uma from 9/1/89 through 10/31/93 (''accidental group''). Male patients referred to Child Protection Services for suspected sexual abuse from 1/1/93 through 12/31/95 who had abnormal genital physical findings (' 'sexual abuse group''). Main outcome measures: Outcomes measured inclu ded age, mechanism of injury, category of diagnosis, location of injur y, and type of injury. Results: Forty-four male patients comprised the accidental group, aged six months to 17 years. The most common mechan ism was a fall onto an object (34%), The most common injuries were lac erations/perforations of the scrotum (36%) followed by penile lacerati ons/perforations (25%), No patient had an isolated rectal laceration. Forty-four male patients with positive physical findings comprised the sexual abuse group. Ages ranged from seven months to 18 years. All pa tients had rectal lesions. Penile lacerations/perforations were the on ly other injuries documented, occurring in two patients. Conclusions: Accidental rectal/genital trauma in the pediatric population is uncomm on; scrotal trauma occurs much more frequently than rectal trauma. Rec tal/genital injury in the sexual abuse group typically involves only t he rectal area. Sexual assault should be considered in patients with i solated rectal injury or whenever the alleged history does not correla te with physical findings.