• H A Beiler, Z Zachariou, and R Daum.
• Department of Pediatric Surgery, Ruprecht-Karls-University, Heidelberg, Germany.
• J. Pediatr. Surg. 1998 Aug 1; 33 (8): 1287-91.

Background/PurposeBecause of the small numbers of impalement and anorectal injuries in childhood, a standardized therapeutic approach is necessary to avoid major complications. On the basis of a retrospective analysis of 12 children with such injuries treated from 1986 to 1996 in our department, the authors tried to establish guidelines for their treatment.MethodsAdditional therapeutic problems and main complications are elucidated after meticulous analysis of three selected cases.ResultsIn two cases of anorectal impalement and a primary colostomy, no complications occurred. However, in three cases involving anorectal injury a primary fecal diversion was not performed, making a secondary colostomy necessary afterwound infection.ConclusionsThe current standard principles in the treatment of severe anorectal injuries in children are fecal diversion, wound drainage, and broad spectrum antibiotics. A primary reconstruction in cases of impalement can be recommended only after exclusion of anorectal injury.

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