Primary anastomosis in necrotizing enterocolitis: the first option to consider

Introduction

Necrotizing enterocolitis (NEC) is the most frequent gastrointestinal emergency in preterm newborns. Thirty percent of all cases will require surgical intervention. Following resection of the involved segment, most patients will undergo a diverting enterostomy.

Objective

To describe the safety and effectiveness of primary anastomosis in patients with complicated NEC.

Methods

This study was a retrospective chart review. The study participants were obtained from both public and private health systems between December 2004 and December 2009 in Santiago, Chile. The inclusion criteria were any patient who underwent a laparotomy for necrotizing enterocolitis. The following variables were evaluated: gestational age, birth weight, use of peritoneal drains, macroscopic features of the intestinal segment, number of anastomoses, parenteral nutrition requirements and post-surgical complications.

Results

Seventy patients were identified. Sixty patients (85?%) underwent primary anastomosis. The remaining 10 patients underwent a resection with enterostomy. In the primary anastomosis group (n?=?60), twelve percent weighed <1,000?g and 22?% weighed 1,000–1,500?g. Two anastomoses were required in 18 patients. Post-surgical complications included infection of the surgical wound in three cases and anastomotic dehiscence in only one case. Seven percent developed short bowel syndrome. Overall mortality was 11.6?%, all secondary to sepsis.

Conclusion

In this series, primary anastomosis was a safe alternative in the management of complicated NEC, with low morbidity and mortality, independent of age, weight, intraperitoneal contamination or extent of disease.     

Laparoscopic-assisted divided colostomy for anorectal malformation case series: a description of technique,clinical outcomes and a review of the literature

Objective

To present a case series of pediatric patients who underwent a laparoscopic-assisted divided colostomy for anorectal malformations, describe our technique, and provide a review of the literature on laparoscopic-assisted colostomy in pediatric patients.

Methods

We performed a retrospective review of six patients born with anorectal malformations, who received a laparoscopic-assisted colostomy from 2012 to 2016 at Cardinal Glennon Children’s Medical Center.

Results

The average operating time was 74.5 min. Laparoscopic colostomy types included divided (n?=?5) and end colostomy with Hartmann’s (n?=?1). Location of the colostomy was selected just distal to the descending colon (n?=?5) or at the sigmoid flexure (n?=?1). Feeds and stoma production was achieved within 24 h from surgery in most patients. There were no major complications except one patient having a mucosal fistula prolapse that was easily reduced.

Conclusions

Laparoscopic-assisted colostomy in the management of anorectal malformations is a safe and effective technique. It offers similar advantages of the open technique, with the added benefits of avoiding wound-related complications and improved cosmetic results.

     

Hepatic involvement of Langerhans cell histiocytosis in children—imaging findings of computed tomography,magnetic resonance imaging and magnetic resonance cholangiopancreatography

Background

Langerhans cell histiocytosis is a rare disease that occurs mainly in children, and hepatic involvement is generally a poor prognostic factor.

Objective

To describe CT and MRI findings of hepatic involvement of Langerhans cell histiocytosis in children, especially the abnormal bile duct manifestation on magnetic resonance cholangiopancreatography (MRCP).

Materials and methods

Thirteen children (seven boys, six girls; mean age 28.9 months) were diagnosed with disseminated Langerhans cell histiocytosis. They underwent CT (n?=?5) or MRI (n?=?4), or CT and MRI examinations (n?=?4) to evaluate the liver involvement.

Results

Periportal abnormalities presented as band-like or nodular lesions on CT and MRI in all 13 children. The hepatic parenchymal lesions were found in the peripheral regions of the liver in seven children, including multiple nodules on MRI (n?=?6), and cystic-like lesions on CT and MRI (n?=?3). In 11 of the 13 children the dilatations of the bile ducts were observed on CT and MRI. Eight of the 13 children underwent MR cholangiopancreatography, which demonstrated stenoses or segmental stenoses with slight dilatation of the central bile ducts, including the common hepatic duct and its first-order branches. The peripheral bile ducts in these children showed segmental dilatations and stenoses.

Conclusion

Stenosis of the central bile ducts revealed by MR cholangiopancreatography was the most significant finding of liver involvement in Langerhans cell histiocytosis in children.     

The impact of preparation and support procedures for children with sickle cell disease undergoing MRI

Background

Children with sickle cell disease (SCD) often undergo MRI studies to assess brain injury or to quantify hepatic iron. MRI requires the child to lie motionless for 30–60?min, thus sedation/anesthesia might be used to facilitate successful completion of exams, but this poses additional risks for SCD patients. To improve children’s ability to cope with MRI examinations and avoid sedation, our institution established preparation and support procedures (PSP).

Objective

To investigate the impact of PSP in reducing the need for sedation during MRI exams among children with SCD.

Materials and methods

Data on successful completion of MRI testing were compared among 5- to 12-year-olds who underwent brain MRI or liver R2*MRI with or without receiving PSP.

Results

Seventy-one children with SCD (median age 9.85?years, range 5.57–12.99?years) underwent a brain MRI (n?=?60) or liver R2*MRI (n?=?11). Children who received PSP were more likely to complete an interpretable MRI exam than those who did not (30 of 33; 91% vs. 27 of 38; 71%, unadjusted OR?=?4.1 (P?=?0.04) and OR?=?8.5 (P?<?0.01) when adjusting for age.

Conclusion

PSP can help young children with SCD complete clinically interpretable, nonsedated MRI exams, avoiding the risks of sedation/anesthesia.     

Safety of cardiac magnetic resonance and contrast angiography for neonates and small infants: a 10-year single-institution experience

Background

With increasing applications of cardiac magnetic resonance (CMR) and magnetic resonance angiography (MRA) for evaluation of congenital heart disease (CHD), safety of this technology in the very young is of particular interest.

Objective

We report our 10-year experience with CMR in neonates and small infants with particular focus on the safety profile and incidence of adverse events (AEs).

Materials and methods

We reviewed clinical, anesthesia and nursing records of all children ≤120?days of age who underwent CMR. We recorded variables including cardiac diagnosis, study duration, anesthesia type and agents, prostaglandin E1 (PGE1) dependence and gadolinium (Gd) use. Serially recorded temperature, systemic saturation (SpO₂) and cardiac rhythm were analyzed. Primary outcome measure was any AE during or <24?h after the procedure, including minor AEs such as hypothermia (axillary temperature ≤95 °F), desaturation (SpO₂ drop ≥10% below baseline) and bradycardia (heart rate ≤100?bpm). Secondary outcome measure was unplanned overnight hospitalization of outpatients.

Results

Children (n?=?143; 74 boys, 69 girls) had a median age of 6?days (1–117), and 98 were ≤30?days at the time of CMR. The median weight was 3.4?kg (1.4–6?kg) and body surface area 0.22?m² (0.13–0.32?m²). There were 118 (83%) inpatients (108 receiving intensive care) and 25 (17%) outpatients. Indications for CMR were assessment of aortic arch (n?=?57), complex CHD (n?=?41), pulmonary veins (n?=?15), vascular ring (n?=?8), intracardiac mass (n?=?8), pulmonary artery (n?=?7), ventricular volume (n?=?4), and systemic veins (n?=?3). CMR was performed using a 1.5-T scanner and a commercially available coil. CMR utilized general anesthesia (GA) in 86 children, deep sedation (DS) in 50 and comforting methods in seven. MRA was performed in 136 children. Fifty-nine children were PGE1-dependent and 39 had single-ventricle circulation. Among children on PGE1, 43 (73%) had GA and 10 (17%) had DS. Twelve children (9%) had adverse events (AEs)—one major and 11 minor. Of those 12, nine children had GA (10%) and three had DS (6%). The single major AE was respiratory arrest after DS in a neonate (resuscitated without sequelae). Minor AEs included desaturations (n?=?2), hypothermia (n?=?5), bradycardia (n?=?2), and bradycardia with hypoxemia (n?=?2). Incidence of minor AEs was 9% for inpatients (vs. 4% for outpatients), and 8% for neonates (vs. 9% for age ≥30?days). Incidence of minor AEs was similar between PGE1-dependent infants and the non-PGE1 group. There were no adverse events related to MRA. Of 25 outpatients, 5 (20%) were admitted for overnight observation due to desaturations.

Conclusion

CMR and MRA can be accomplished safely in neonates and infants ≤120?days old for a wide range of pre-surgical cardiac indications. Adverse events were unrelated to patient age, complexity of heart disease, type of anesthesia or PGE1 dependence.     

Role of Gastric Lavage in Vigorous Neonates Born with Meconium Stained Amniotic Fluid

Objective

To compare reduction in incidence of feed intolerance in neonates born with meconium stained amniotic fluid (MSAF) by use of gastric lavage to those who did not receive lavage.

Methods

This Randomized controlled trial was conducted in all vigorous newborns delivered through MSAF, with birth weight ≥1800 g and gestation ≥34 wk. In the lavage group, gastric lavage with 10 ml/kg of normal saline was done.

Results

Twelve neonates in the lavage group (n?=?124) developed feed intolerance compared to 16 neonates in control group (n?=?120), (p?=?.309; OR 0.69; 95%CI 0.27–1.58). No difference in any other morbidity was noted.

Conclusions

Gastric lavage in neonates with MSAF does not reduce feed intolerance, irrespective of thickness of MSAF and it confers no advantages.     

Magnetic resonance imaging in children with sickle cell disease—detecting alterations in the apparent diffusion coefficient in hips with avascular necrosis

Background

Avascular necrosis (AVN) is a common morbidity in children with sickle cell disease (SCD) that leads to pain and joint immobility. However, the diagnosis is often uncertain or delayed.

Objective

To examine the ability of apparent diffusion coefficient (ADC) measurements on diffusion-weighted imaging to detect AVN in children with SCD.

Materials and methods

ADC values were calculated at the hips of normal children (n?=?19) and children with SCD who were either asymptomatic with no known previous hip disease (n?=?13) or presented for the first time with clinical symptoms of hip pathology (n?=?12). ADC values were compared for differences among groups with and without AVN using non-parametric statistical methods.

Results

The ADC values were elevated in the hips of children with AVN (median ADC?=?1.57?×?10^?3?mm²/s [95% confidence interval?=?0.86–2.10]) and differed significantly in pairwise comparisons (all P?Conclusion Children with sickle cell disease have elevated apparent diffusion coefficient values in their affected hips on initial diagnosis of avascular necrosis.     

MRI of radiographically occult ischial apophyseal avulsions

Background

Acute avulsions of unossified ischial apophyses in children may go undetected on radiography. Therapy includes rest and rehabilitation; however, substantial displacement may require surgery.

Objective

Our purpose is to illustrate the utility of MRI in the detection of these radiographically occult injuries in skeletally immature children.

Materials and methods

This retrospective study of more than 5?years included children with ischial avulsions who were evaluated with both radiography and MRI within 3?weeks of acute injury. Initially, radiographs were reviewed to identify those children with unossified ischial apophyses. Subsequently, their MRI examinations were assessed for physeal disruption, bone/soft tissue edema, periosteal/perichondrial elevation and disruption. Initial and follow-up radiographs (if available) were reviewed. Patient age, symptoms and offending activity were determined from clinical records.

Results

Five children met inclusion criteria. All initial radiographs were normal. MRI showed: edema (n?=?5), periosteal elevation (n?=?4), periosteal/perichondrial disruption (n?=?4), >5.5?mm displacement (n?=?0). Follow-up radiographs in two children (2 and 2.5?months from MRI) showed osseous ischial irregularity. The apophyses remained unossified.

Conclusions

Acute unossified ischial apophyseal avulsions in children may be radiographically undetected. In the setting of correlative clinical symptoms, MRI can be used to identify these injuries and to help direct appropriate therapy.     

Alveolar soft part sarcoma—radiologic patterns in children and adolescents

Background

Alveolar soft part sarcoma is a rare but highly malignant tumour and little is known about its radiologic pattern in children.

Objective

To describe the radiologic features of alveolar soft part sarcoma in children and adolescents.

Materials and methods

We retrospectively analysed the clinical and imaging data of six children age 7–17 years at diagnosis, with histologically or genetically proven alveolar soft part sarcoma.

Results

The tumours were located deep within muscles of the limbs (n?=?4), in chest wall muscle (n?=?1) and in the orbit (n?=?1). High-flow feeding arteries, large drainage veins and intense enhancement were consistent findings by all imaging modalities. At MRI, all tumours demonstrated high signal intensity on T2-weighted images and high or iso-intense signal on T1-W imaging compared to muscle. In tumours larger than 70 mm in one dimension (n?=?3/6), large vessels converging toward the tumour centre led to a highly vascularised central stellar area pattern. Five children demonstrated synchronous (n?=?4/5) and metachronous (n?=?1/5) lung metastases.

Conclusion

Alveolar soft part sarcoma should be suggested when a highly vascularised, intramuscular mass demonstrating large feeding and drainage vessels converging toward a central stellar area is seen in children, especially if synchronous lung metastases are present.     

Contrast-enhanced voiding urosonography with intravesical administration of a second-generation ultrasound contrast agent for diagnosis of vesicoureteral reflux: prospective evaluation of contrast safety in 1,010 children

Background and objective

To evaluate the safety of intravesical administration of a second-generation ultrasound (US) contrast agent for the diagnosis of vesicoureteral reflux in children.

Materials and methods

One thousand and ten children (563 girls, 447 boys; mean age: 2.9 years, range: 15 days-17.6 years) with 2,043 pelvi-ureter-units underwent contrast-enhanced voiding urosonography (ce-VUS) to rule out vesicoureteral reflux. A second-generation US contrast agent (SonoVue®, Bracco, Milan) was administered intravesically through transurethral bladder catheterization at a dose of 0.5 ml/bladder filling. Possible adverse events were monitored during the examination and followed up for 7 days after ce-VUS by phone calls. Urine analysis and culture were performed 3–5 days before ce-VUS in all children and 24–48 h in any patient who reported with adverse events.

Results

No case of serious adverse event was recorded. Minor events were reported in 37 children (3.66% of the study population). These included dysuria (n?=?26, 2.57%), urinary retention (n?=?2, 0.2%), abdominal pain (n?=?2, 0.2%), anxiety (n?=?1, 0.1%) and crying (n?=?1, 0.1%) during micturition, blood and mucous discharge (n?=?1, 0.1%), increased frequency of micturition (n?=?1, 0.1%), vomiting (n?=?1, 0.1%), perineal irritation (n?=?1, 0.1%), and an episode of urinary tract infection 10 days after ce-VUS (n?=?1, 0.1%). Of these adverse events, 91.9% were subacute in onset and 8.1% were delayed. All events were self-limited and none required hospitalization.

Conclusion

There were no serious adverse events. Only a few minor events were reported, most likely due to the catheterization process. Thus, ce-VUS with intravesical administration of the second-generation US contrast agent (SonoVue®) for vesicoureteral reflux detection or exclusion had a favorable safety profile in our study group.     

Association of initial CT findings with quality-of-life outcomes for traumatic brain injury in children

Background

Traumatic brain injury (TBI) is a leading cause of acquired disability in children and adolescents.

Objective

To demonstrate the association between specific findings on initial noncontrast head CT and long-term outcomes in children who have suffered TBI.

Materials and methods

This was an IRB-approved prospective study of children ages 2–17?years treated in emergency departments for TBI and who underwent a head CT as part of the initial work-up (n?=?347). The change in quality of life at 12?months after injury was measured by the PedsQL scale.

Results

Children with TBI who had intracranial injuries identified on the initial head CT had a significantly lower quality-of-life scores compared to children with TBI whose initial head CTs were normal. In multivariate analysis, children whose initial head CT scans demonstrated intraventricular hemorrhage, parenchymal injury, midline shift ≥5?mm, hemorrhagic shear injury, abnormal cisterns or subdural hematomas ≥3?mm had lower quality of life scores 1?year after injury than children whose initial CTs did not have these same injuries.

Conclusion

Associations exist between findings from the initial noncontrast head CT and quality of life score 12?months after injury in children with TBI.     

Laparoscopy-assisted surgery for neonatal intestinal atresia and stenosis: a report of 35 cases

Purpose

Jejunal?Cileal atresias are the most common causes of intestinal occlusion in neonatal period. Treatment is classically performed by a right upper quadrant transverse laparotomy. Our study aimed to present our initial experience of intestinal atresia in newborn treated with laparoscopic assisted approach.

Methods

Overall 35 small intestinal atresias, which occurred in infants from September 2009 to July 2012 in our hospital, were treated by laparoscopy-assisted procedure. After carefully inspecting through laparoscope by a multi-port or single-site approach, these were definitely diagnosed. The anastomosis of intestinal atresia was manually performed after exteriorization of the bowel via the umbilical port site incision.

Results

There were no conversions to an open procedure and no intraoperative various complications. The incision of umbilical port was about 2?C2.5?cm. The post-operative course was uneventful.

Conclusion

Laparoscopy-assisted procedure could be safely accomplished in neonates with intestinal atresia. Comparing to open surgery, parents were extremely satisfied with the cosmetic results. The early experience suggests that the outcomes are excellent.     

Imaging features of medulloepithelioma: report of four cases and review of the literature

Background

Intraocular medulloepithelioma is a childhood tumor arising from the nonpigmented primitive ciliary neuroepithelium. Although rarer than retinoblastoma, it remains the second most common primary intraocular neoplasm in children. The rarity of intraocular medulloepithelioma creates the challenge in establishing a clinical diagnosis, and radiologically the tumor is often confused with other intraocular masses.

Objective

To describe the clinical, imaging and pathological features of intraocular medulloepithelioma with emphasis on the role of imaging to enable its differentiation from more common intraocular pathology.

Materials and methods

We retrospectively analyzed the clinical, histopathological and imaging data of four children with intraocular medulloepithelioma.

Results

All four children had medulloepithelioma arising from the ciliary body. The children were imaged with US (n?=?3), MRI (n?=?4), whole-body ^99mTc-MDP scintigraphy (n?=?2) and CT (n?=?1). All four children had enucleation of the involved eye. One tumor was a malignant teratoid variant, two tumors were malignant nonteratoid variants and one was a nonteratoid variant of uncertain malignant potential. None of the tumors had extraocular extension on histopathology or imaging. Two children had associated retinal detachment on US and MRI examinations. All tumors were iso/hyperintense to vitreous on T1-weighted and hypointense on T2-weighted MRI and showed marked contrast enhancement of the solid components. No calcifications were identified on US or CT examinations.

Conclusion

Our findings are consistent with previously reported cases of medulloepithelioma. This series emphasizes the roles of various imaging modalities, with pathological correlation, in differentiating the tumor from other ciliary body masses, in detecting tumor extension and in identifying associated ocular complications. In this series we also describe the results of postsurgical follow-up for tumor recurrence.     

Impact of relationship between the stoma site and the primary incision on occurrence of laparotomy wound infection in contaminated or dirty wound operations in neonates

Background

In neonatal surgical patients requiring an enterostomy, there is no definitive recommendation regarding the ideal enterostomy location: at the edge of the primary incision or at a different incision.

Methods

We retrospectively reviewed 2005–2017 administration data in our institution. All neonatal patients who underwent contaminated or dirty wound laparotomy and enterostomy construction were evaluated regarding the enterostomy location, occurrence of postoperative incisional surgical-site infection (SSI) at the primary incision, and stoma-related complications.

Results

Patients were divided into two groups based on stoma location: at the primary incision (the same incision group: SI group, n?=?16) or at another incision (different incision group: DI group, n?=?23). We performed 2 jejunostomies, 13 ileostomies, and 1 colostomy in the SI group, and 4 jejunostomies, 18 ileostomies, and 1 colostomy in the DI group. One of 16 patients (6.3%) in the SI group and 2/23 patients (8.7%) in the DI group experienced superficial incisional SSI, with comparable SSI incidence between groups (p?=?0.78). Every SSI did not result in stoma-related complications.

Conclusions

Although the enterostomy location did not influence the incidence of laparotomy wound infection in this study, prospective studies are mandatory to fully assess the safety of enterostomy construction at the edge of the primary incision.

     

Adolescent Kawasaki disease: usefulness of 64-slice CT coronary angiography for follow-up investigation

Background

Kawasaki disease (KD) is a systemic vasculitis that mainly affects coronary arteries in children, and requires regular follow-up from the time of diagnosis.

Objective

To evaluate the feasibility of 64-slice CT angiography (CTA) for follow-up of patients with KD using previously performed invasive catheter coronary angiography (CCA) as reference standard.

Materials and methods

The study group comprised 12 patients (age 17.6?±?2.9?years, mean±SD) with a diagnosis of KD and a previously performed CCA (interval, 32.6?±?13.5?months) who underwent 64-slice cardiac CTA. The quality of the images for establishing the presence of coronary abnormalities was determined by two observers. The CTA findings were compared with those from the prior CCA.

Results

Adequate image quality was obtained in all patients. Mean effective dose for CTA was 6.56?±?0.95?mSv. CTA allowed accurate identification, characterization and measurement of all coronary aneurysms (n?=?32), stenoses (n?=?3) and occlusions (n?=?9) previously demonstrated by CCA. One patient with disease progression went on to have percutaneous coronary intervention.

Conclusion

Coronary lesions were reliably evaluated by 64-slice CTA in the follow-up of compliant patients with KD, reducing the need for repeated diagnostic invasive CCA. Hence, in an adequately selected patient population, the role of CCA could be limited almost only to therapeutic procedures.     

Damage control laparotomy for abdominal trauma in children

Background

Damage control laparotomy (DCL) is not well studied in the pediatric trauma population. The purpose of this study was to develop a surrogate definition of DCL compatible with national and administrative data sources so that the rate and outcomes of DCL in pediatric trauma patients could be determined.

Methods

Using the 2010–2014 National Trauma Data Bank, children ≤18 with an abdominal AIS?≥?3 who underwent a laparotomy within 3 h of arrival were identified (n?=?2989). DCL was defined as occurring in children who underwent a second laparotomy within 5–48 h from the index laparotomy (n?=?360). Children meeting these criteria were compared to those children who had the initial definitive operative management (n?=?2174) and those who died prior to 48 h (n?=?455).

Results

DCL occurred in 12% of children with operative abdominal trauma. Children who underwent DCL had a greater median ISS (25 vs 18) and heart rate (112 vs 100), lower systolic blood pressure (104 vs 113), and GCS (12 vs 13), and were more likely to receive a preoperative blood transfusion (19 vs 11%) than those who had definitive initial operative management (all p?<?.05). Median length of stay (17 vs 8 days) and mortality (9 vs 2%) were greater following DCL than definitive initial operative management (p?<?.001). No differences in rate of DCL were seen based on ACS pediatric verification (p?=?.07).

Conclusions

Few children with operative abdominal trauma undergo DCL. DCL was associated with worse physiology rather than anatomic injury severity in this study. As expected, outcomes were worse following DCL.

     

Enteroclysis in older children and teenagers

Background

Enteroclysis (EC) has been widely and successfully used for evaluation of the small bowel in adults for about 30 years. However, despite recently improved intubation and examination techniques, in many paediatric radiology centres it is still not the preferred conventional barium study for the evaluation of small bowel pathology in children.

Objective

To share our 10 years of experience and review the feasibility of EC in 83 older children and teenagers, in terms of both technique and pathological findings.

Materials and methods

Between 1996 and 2006, EC was performed by the standard technique described by Herlinger to 83 children between 7 and 18 years of age. The indication for the study was jointly decided by the paediatric radiologist and the clinician. None of the examinations was converted to follow-through studies because of patient refusal or technical failure. Morphological changes, mucosal abnormalities, luminal abnormalities, perienteric structures, the location of the disease, indirect findings regarding the bowel wall and functional information were evaluated.

Results

All the children tolerated the procedure without difficulty. Out of 83 patients, 63 had abnormal findings. The spectrum of diagnoses were Crohn disease (n?=?23), nonspecific enteritis (n?=?10), malabsorption (n?=?8), intestinal tuberculosis (n?=?6), intestinal lymphoma (n?=?5), Peutz-Jegher syndrome (n?=?3), adhesions (n?=?2), Behçet disease (n?=?2), back-wash ileitis due to ulcerative colitis (n?=?2), common-variable immune deficiency (n?=?1) and lymphangiectasis (n?=?1).

Conclusion

EC can easily be performed in children over 7 years of age and when performed using a correct technique it shows high diagnostic performance without any complications in the evaluation of small bowel diseases in older children and teenagers.

     

Straddle Injuries in Female Children and Adolescents: 10-year Accident and Management Analysis

Objective

To analyze unintentional straddle injuries in girls with regards to epidemiology, etiology and injury management.

Methods

The hospital database was retrospectively reviewed (1999–2009) for female patients managed for genital trauma. Patients were evaluated based on age, causative factors, type of injury, area of genitals affected, management and outcomes.

Results

Straddle injuries were documented in 91 girls with age ranging from 1 to 15 y (mean?=?6.3 y; median?=?6.1 y). The causes of injuries were falls at home (n?=?31) or outdoors (n?=?27), and sport activities (swimming pool n?=?11, skating n?=?11, bicycle n?=?9 and scooter n?=?2). Most of the injuries were lacerations. Injuries involved major labia (n?=?56), minor labia (n?=?45) and introitus vaginae (n?=?15). Twelve children received outpatient treatment. Inspection under anesthesia was performed in 79 patients, with 76 requiring sutures. While hematuria was observed in 18 patients, cystoscopy did not reveal lesions in the urethra or bladder. Associated injuries were femur fracture (n?=?1), lower extremity lacerations (n?=?4) and anal lesions (n?=?2). Follow-up investigations were uneventful; however one patient developed a secondary abscess and another secondary hyperplasia of the labia minor.

Conclusions

Falls and sports are major causes of straddle injuries with a peak at the age of six years. Lacerations are the most common injuries and often require surgical management. Urinary tract injuries and other associated injuries are relatively uncommon in girls with straddle injuries.