Impaling Injury
Information has been excerpted from VisualDx clinical decision support system as a public health service. Additional information, including symptoms, diagnostic pearls, differential diagnosis, best tests, and management pearls, is available in VisualDx.
Synopsis
Although genital injury is not uncommon, it often elicits anxiety from parents of injured, young children. In childhood, the main cause of penetrating perineal injury is impalement. However, in every case of vaginal, anorectal, penile, or scrotal injury, sexual abuse must be ruled out.
There have been documented cases of impalement on broom or toilet-brush handles, pogo sticks, chair legs, bicycle seat poles, sprinklers, high jump bars, and tree branches.
Look For
You may see bleeding or hematoma, abrasions, or lacerations on the vagina, hymen, scrotum, penis, or rectum. External genitalia are highly vascularized, and a small injury may bleed significantly. The child may cry inconsolably and may be difficult to examine. The force may have been symmetric or asymmetric. A symmetric wound with a transected hymen would indicate that the weakest point in the perineal floor has received a large part of the force. It is through this point that injury to the internal pelvic and abdominal organs is possible. Even if the child is having minimal bleeding and is in no apparent distress, the possibility of higher visceral injury is significant, especially in cases of symmetric injury with hymenal transections. On the other hand, if the object is too small to penetrate deeply, even if there is a large amount of visible blood, there may be minimal trauma internally, such as with asymmetric, non-transecting injuries. Regardless, adequate examination may require exploration in the operating room under general anesthesia.
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