ABSTRACT
A 2-month-old baby boy was brought for evaluation because of bleeding that was noticed in his diaper. His mother noticed bleeding from his penis and a few red drops of blood on his diaper/nappy. There was no history of trauma. His mother stated he was in an infant carrier and maybe the straps were too tight around him. He had been active and eating well with no other complaints. His exam is shown in Image 123. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig123.jpg"/>
What injury does the image show?
Would you have any further concerns?
280The image shows this child’s penis. There was an abrasion noted to the tip of his penis measuring 1 cm and involving the urethral meatus. The abrasion was surrounded by ecchymosis. The remainder of his physical examination did not show any further bruises or signs of trauma.
In a 2-month-old child, a genital injury raised the possibility of sexual as well as physical abuse. 1 Anogenital injuries may result from accidents or from abuse. Straddle injury is the most common mechanism of accidental anogenital injury which is a blow to the perineum as a result of falling or striking a surface or an object with the force of one’s own body weight. Male straddle injuries most commonly involve the scrotum, followed by penile trauma. 2 An investigation was initiated for this child due to his young age and the absence of history to explain the clinical finding. A complete blood count, liver enzymes and skeletal survey were done and were normal. An investigation by Child Protective Services was also conducted in this case.
