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Abnormal anus and hymen in a toddler: A case report
Nancy D Kellogg1,2, Lora R Spiller1,2
1Division of Child Abuse, Department of Pediatrics, University of Texas Health Science Center at San Antonio, TX, USA.
Insights
A young child presented with genital concerns, revealing a perineal defect and posterior hymen absence. Further examination confirmed a perineal fistula, highlighting the need for thorough newborn anogenital assessments.
Area of Science:
- Pediatric Surgery
- Forensic Medicine
- Anatomy
Background:
- A 2-year-old girl presented with genital complaints, raising concerns for sexual abuse.
- Physical examination revealed a perineal defect and absence of a posterior hymen segment, with no history of trauma.
- No other signs of abuse or neglect were observed.
Observation:
- A 2-year-old female presented with genital complaints, exhibiting a perineal defect and absent posterior hymen segment.
- Physical examination revealed no other signs of abuse or neglect.
- A perineal fistula was confirmed during an exam under anesthesia.
Findings:
- The presence of a large posterior hymenal defect, typically associated with trauma, co-occurred with an anatomical variant of the anus and perineum.
- The etiology of both the hymenal defect and the anatomical variant remains unclear, questioning a purely traumatic cause.
Implications:
- This case emphasizes the critical need for meticulous anogenital examinations in newborns to document anatomical variants.
- Early identification of congenital anomalies can prevent misdiagnosis and inappropriate interventions, particularly in cases with potential abuse concerns.
- Comprehensive documentation of newborn anogenital structures is crucial for future medical evaluations and forensic assessments.
Abstract:
A 2-year-old girl presented to the Emergency Department with genital complaints and a concern for sexual abuse. A perineal defect and absence of a segment of the posterior hymen were observed; the caregiver denied a past history of trauma. No other signs consistent with abuse or neglect were noted on examination. Pediatric surgery conducted an exam under anesthesia and confirmed a perineal fistula. While trauma is the most likely explanation for a large segmental defect in the posterior hymen, the co-occurrence of an anatomical variant of the anus and perineum in this patient raises questions about the etiology of both findings. This case underscores the importance of adequate examinations with careful inspection and documentation of anogenital structures in the newborn period.
