ABSTRACT
A 1-year-old girl presented for medical care with rectal bleeding. Her mother stated she was walking in the home and tripped. When she fell, her mother describes the child’s bottom hitting a metal rod that was sticking out of the child’s crib. Her mother stated she was setting up the crib and the rod was perpendicular to the floor, so when the child fell on top of it, it pierced her diaper/nappy. The child cried immediately and the mother noticed the blood in the diaper/nappy and brought her to the emergency department where an examination was done (Images 110a and 110b). https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig110a.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig110b.jpg"/>
What injury do the images show?
Is the injury consistent with the history provided?252
https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig110c.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig110d.jpg"/>Images 110a and 110b show two anal lacerations at the areas of 4 and 6 o’clock, which were 1 cm in length. The bleeding stopped when the wound was cleaned. Her genital examination was normal with no acute or chronic signs of trauma as was the remainder of her physical exam.
The injury is thought to be consistent with the history provided. The mother had saved the diapers as seen in Images 110c and 110d. The diaper/nappy was full when the child tripped and a full diaper can be pierced much easier than a dry one. It was felt that the fall on top of the metal rod would puncture the diaper and cause the injury to the anus. The mother stated that when she saw the blood, she used the diaper to wipe the child’s bottom, thus the blood on the diaper/nappy in different places. There was no delay in medical care and the remainder of the physical examination was otherwise normal. Child Protective Services were notified and they visited the home to make sure there were no other safety concerns. The child was followed up at the children’s advocacy centre and the wounds had healed well with conservative management. It is important in these cases to obtain a full medical history and examination as well as a social work assessment of the family to identify any additional concerns. Anal injuries heal externally very quickly and it is important to ascertain whether there is potentially deeper, more life-threatening injury and to document these injuries. 1 , 2 Forensic trace evidence can also be collected before any cleansing or operative repair.
