Pediatric emergency medicine trisk 4227 4227
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TABLE 127.1
CONDITIONS MISTAKEN FOR SEXUAL ABUSE TRAUMA
Variants of normal
anatomy
Nonabusive trauma
Vestibular bands (periurethral, hymenal); hymenal
skin tags, septa, clefts; median raphe; linea
vestibularis (hymen, posterior fourchette);
perianal erythema; anal dilation; failure of
midline fusion
Straddle injuries; impalement to anogenital
structures; zipper injuries; suction drain injury;
toilet seat injury
Dermatologic
Lichen sclerosus; seborrheic, atopic, or contact
dermatitis; psoriasis; hemangioma,
pseudoverrucous perianal papules
Infectious
Staphylococcus aureus (impetigo); Group A
streptococcus (balanitis, vaginitis, anal); shigella
or salmonella (infectious diarrhea); human
papillomavirus (perinatal and horizontal
transmission); molluscum contagiosum;
autoinoculation of oral HSV infection or herpetic
whitlow; scabies; diaper candidiasis; parasitic
(pinworms)
Inflammatory/allergic Crohn disease; Kawasaki disease; Behỗet
syndrome; erythema multiforme; Stevens
Johnson syndrome, milk-protein allergy
Miscellaneous
Idiopathic thrombocytopenic purpura; prolapse
(urethral, rectal); labial fusion; hair tourniquet;
retained foreign body
Clinical Recognition
While many patients will present to the ED with a chief complaint of assault
or abuse, the ED clinician should consider the potential for sexual assault in
patients with injuries that do not match the provided history.
Triage
