Pediatric emergency medicine trisk 1544 1544
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necessary to ensure that a retained foreign body is removed to prevent
complications such as fistula formation and vaginal stenosis.
Infections
About half of all patients with Shigella vaginitis have bleeding that may be more
noticeable than vaginal discharge. Most patients do not have concurrent diarrhea.
Vaginal infections with group A streptococci, N. gonorrhoeae, and C. albicans
also cause bleeding in some cases. A vaginal culture will provide the diagnosis
and guide the selection of appropriate therapy. The manifestations and treatment
of vaginal infections in children are discussed in more detail in Chapters 80
Vaginal Discharge and 92 Gynecology Emergencies .
Tumors
Malignant tumors, such as endodermal sinus tumors and rhabdomyosarcomas
including sarcoma botryoides are a rare cause of vaginal bleeding in young
females. Sarcoma botryoides presents as a polypoid, “grape-like” mass protruding
from the introitus and often has metastasized to the lungs, pericardium, liver,
kidney, and bones when initially diagnosed. Peak incidence is 2 years of age but
this can present between 1 and 5 years old. Pelvic ultrasound can aid with this
diagnosis. A pediatric gynecologist and oncologist should be consulted
immediately because treatment requires surgical excision, chemotherapy, and
radiation therapy after a tissue biopsy.
Vascular Anomalies
Vascular anomalies, such as malformations or tumors, may cause vaginal
bleeding in young children. Infantile hemangiomas, which can appear anywhere
along the body, are the most common vascular tumor, occurring in up to 10% of
white, non-Hispanic females. They are often associated with prematurity and
infants of mothers with multiple gestation, advanced maternal age, placenta
previa, or preeclampsia. They typically present in the first weeks of life and tend
to regress spontaneously. Infrequently, they may lead to ulceration and bleeding.
Treatment with corticosteroids, laser therapy, and possible excision may be
necessary.
Urethral Bleeding
Urethral prolapse (see Chapter 92 Gynecology Emergencies ) is a common cause
of prepubertal vaginal bleeding. Urethral prolapse more commonly affects
school-aged African-American children. The etiology remains unknown. Factors
contributing to urethral prolapse might include estrogen deficiency, trauma,
