Child Abuse Mimic: Avulsion Injury in a Child with Penoscrotal Webbing

Sexual abuse of children is prevalent in today's society. 

• In 2012, approximately 686,000 children (9.2 per 1000) in the United States were determined to be victims of substantiated child abuse and neglect, according to national data compiled by child protective service agencies; 
• victimization rates were highest for children younger than 1 year. 
• Nearly 9.3% of maltreated children were victims of sexual abuse, 
• this finding was reported by US Department of Health and Human Services (http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment). 
• Previous research has shown that as many as 1 in 3 girls and 1 in 7 boys will be sexually abused during childhood (Child Abuse Negl. 2003;27:1205-1222). 
• Although sexual abuse seems to be less common in boys than girls, this may be partly due to under diagnosis and under reporting of sexual abuse in boys (Arch Dis Child. 2007;92:328-331). 
• Clinicians should therefore consider the possibility of sexual abuse when boys present with genital injuries, because failing to recognize and diagnose sexual abuse can pose an ongoing safety risk to a child. 
• However, an erroneous diagnosis of sexual abuse can have equally hazardous repercussions, including removal of a child from their caregivers or prosecution of an innocent individual. 
• A number of medical conditions can mimic child sexual abuse injuries, including 
• anal fissures, 
• failure of midline fusion, 
• perianal streptococcal dermatitis, and 
• straddle injury 
• (J Pediatr Health Care. 2009;23:283-288 and Acta Paediatr. 2011;100:590-593). 
• The following case involves a 5-week-old male infant who presented to the pediatric emergency department with an avulsion injury to his penis concerning for sexual abuse. 
• He was ultimately diagnosed with a relatively rare anatomic variant of the genitalia and determined to have sustained an accidental injury whose appearance mimicked abuse.

Purchase full article at: http://goo.gl/JlcsXb

By: Deutsch SA1, Long CJ, Srinivasan AK, Wood JN.

• 1From the *Division of General Pediatrics, †Urology, and ‡General Pediatrics and Policy Lab, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA.

More at:  https://twitter.com/hiv_insight