Pediatric perineal trauma: a prospective observational study of mechanisms, surgical management, and outcomes

Paediatric perineal trauma is uncommon but may involve the genital, urinary, anorectal, and pelvic-floor structures. Accurate assessment and individualized reconstruction are essential to preserve function and achieve satisfactory anatomical and cosmetic outcomes. This study evaluated the mechanisms, injury patterns, surgical management, and outcomes of surgically managed paediatric perineal trauma.

This prospective observational study included consecutive children with perineal trauma requiring surgical management at the Children's Hospital and University of Child Health Sciences, Lahore, between October 2020 and October 2021. All patients underwent examination under general anaesthesia, with vaginoscopy, cystoscopy, or proctoscopy performed according to the suspected anatomical involvement. Injuries were categorized using the Genital Injury Score. Functional and cosmetic outcomes were assessed during follow-up.

Twenty-eight children were included; the median age was 6 years (range, 1-11), and 21 (75.0%) were female. Falls onto objects accounted for 15 injuries (53.6%), road traffic accidents for nine (32.1%), and child sexual abuse for four (14.3%). Seven patients had GIS Grade I injuries, three Grade II, five Grade III, five Grade IV, and eight Grade V. All road traffic accident-related injuries were GIS Grade III-V. Vaginoscopy, cystoscopy, and proctoscopy were performed in 21, 11, and 16 patients, respectively. Primary repair was undertaken in 22 patients (78.6%), while six (21.4%) required delayed reconstruction. Eleven patients underwent anal sphincter repair. Three adverse outcomes occurred. Anal sphincter function was good in 23 patients (82.1%), weak in four (14.3%), and absent in one (3.6%). No vaginal stenosis was identified during follow-up.

Examination under general anaesthesia with selective endoscopic evaluation enables accurate assessment of surgically managed paediatric perineal trauma. Primary anatomical repair is feasible in most patients, while delayed reconstruction and selective diversion may be required for infected or complex injuries. Structured multidisciplinary management can achieve favourable functional and cosmetic outcomes.