Patterns of accidental genital trauma in young girls and indications for operative management Corey W. Iqbal a , Nezar Y. Jrebi a , Martin D. Zielinski b , Luis A. Benavente-Chenhalls a , Daniel C. Cullinane b , Scott P. Zietlow b , Christopher R. Moir c , Michael B. Ishitani c, ⁎ a Department of Surgery, Mayo Clinic Rochester, Rochester, MN 55905, USA b Division of Trauma, Critical Care, and General Surgery, Mayo Clinic Rochester, Rochester, MN 55905, USA c Division of Pediatric Surgery, Mayo Clinic Rochester, Rochester, MN 55905, USA Received 25 January 2010; accepted 2 February 2010 Key words: Genital; Gynecologic; Pediatric; Trauma Abstract Background/purpose: The aim of this study was to define the injury patterns of accidental genital trauma (AGT) in female patients and examine the indications and outcomes of operative intervention. Methods: Review of patients younger than 16 years with AGT from 1980 to 2007 excluding sexual- and obstetric-related injuries. Results: One hundred sixty-seven patients met the criteria. Mean (±SEM) age was 6.9 (0.2) years. There were 70.5% straddle injuries, followed by nonstraddle blunt injuries (23.5%) and penetrating injuries (6.0%). Injuries to the labia were most frequent (64.0%). Injuries to the posterior fourchette (7.8%) and hymenal disruption (8.4%) were less frequent. There was 87.9% of AGT that was managed expectantly without further sequelae. Twenty patients (12.1%) were managed operatively. Penetrating injuries were more likely to require operative management (P ≤ .03). The operative group was also more likely to have multiple genital injuries (60% versus 25%, P b .01). Proctoscopy, vaginoscopy, and/or cystoscopy were performed in 55% of patients in the operative group. Conclusions: Accidental genital trauma is most commonly caused by straddle-type injuries and is usually amenable to nonoperative management. Hymenal disruption and injuries to the posterior fourchette are uncommon with these types of injuries. © 2010 Published by Elsevier Inc. Genital injuries in young girls raise concern regarding sexual abuse, and the literature characterizing these injuries has focused on abuse-related causes. However, similar injuries may occur during accidental circumstances, although this scenario is less frequent [1-5]. Because of the relatively low occurrence of accidental genital injuries in this patient population, the literature is deficient in characterizing the findings that are indicative of accidental genital trauma (AGT). This is significant because the existing data indicate that injuries seen with AGT may be distinct by the pattern of injury (specifically hymenal disruption and injuries to the posterior fourchette being more frequent with sexual trauma). This may alter the surgical approach in this subset of patients as well as indicate the need for further investigation into the true mechanism of injury [1,4-6]. Our aim with this review was (a) to examine our institutional experience with the management of AGT to Presented at the 41st Annual Meeting of the Canadian Association of Paediatric Surgeons, Halifax, Nova Scotia, Canada, October 1-3, 2009. ⁎ Corresponding author. E-mail address: ishitani.michael@mayo.edu (M.B. Ishitani). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2010 Published by Elsevier Inc. doi:10.1016/j.jpedsurg.2010.02.024 Journal of Pediatric Surgery (2010) 45, 930–933