Unusual causes of perineal trauma in paediatric patients: lessons learned from a high-volume colorectal clinic in a low-and-middle-income country

PMCID: PMC12176936

PMID: 40533567

DOI: 10.1007/s00383-025-06075-x

Journal: Pediatric surgery international

Publication Date: 2025-6-18

Authors: Palmisani F, Teko K, Bebington C, Brisighelli G

Key Points

• Traditional enemas represent a significant and underrecognized mechanism of pediatric perineal trauma in low-resource settings
• 75% continence rate achieved through surgical reconstruction, with median follow-up of 4 years
• Careful surgical approach and individualized management are critical for optimal functional and cosmetic outcomes in pediatric perineal trauma

Summary

This retrospective study examined surgical management and outcomes of pediatric perineal trauma in a low-and-middle-income country setting, highlighting unique injury mechanisms prevalent in resource-limited environments. Among 20 patients, traditional enemas emerged as a surprisingly common cause of severe perineal injury, accounting for 60% of cases requiring surgical reconstruction, with a median patient age of 3.5 years in the reconstruction group.

The research demonstrated the effectiveness of established anorectal reconstruction techniques, with 75% of patients achieving continence after surgical intervention. Surgical strategies included Swenson pull-through procedures (7 patients), posterior sagittal anorectoplasty (PSARP) (2 patients), and perineal body reconstruction (2 patients). Notably, 70% of patients in the conservative treatment group required colostomy for sepsis-free recovery, underscoring the complexity of managing these traumatic injuries.