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Pediatr Surg Int (2004) 20: 334338 DOI 10.1007/s00383-004-1193-8
ORIGINAL ARTICLE
Agnes M. Pierce
Anal ssures and anal scars in anal abuseare they signicant?
Accepted: 18 November 2003 / Published online: 24 June 2004 Springer-Verlag 2004
Abstract The notes of 214 children who, over a period of 7 years, had been referred after an allegation or a suspicion of any form of child abuse, were examined retrospectively to establish the pattern of injury found, especially with regard to anal ssures or scars. These were all children who had had their genitalia examined at the time of their referral. In 81 children (Group A) who had no history or evidence of sexual abuse, two ssures were found, both with medical explanations for their presence. In 83 (Group B) who alleged sexual abuse but denied anal abuse, nine (11%) had ssures or scars, and in four of the nine there was a history of signicant constipation at some time. In 50 children (Group C) who had a strong history of anal abuse, 41 (84%) had ssures or scars. The diagnosis in 13 of these cases was considered denite because there was a confession or guilty plea from the abuser; in the remainder, the diagnosis was not proven despite a strong history or gross anal signs and regardless of the verdict in court proceedings. The signicance of the ndings was discussed with a view to clarifying the relative importance of anal ssures in children with a strong history of anal abuse.
Keywords Child abuse Anal abuse Anal ssures Anal scars
IntroductionIn child sexual abuse, the signicance of ndings in the vagina and hymen has been well discussed in the literature, and, in the context of anal abuse, several papers have dealt with the possible causes of reex anal dilatation and enlarged veins at the anus. Because there has
been less debate about the signicance of anal ssures and scars found in children who describe anal abuse, this was the aim of this study.
Anal abuse is dicult to prove conclusively [9] unless semen or sexually transmitted disease is found or the classic signs of swelling, multiple ssures, and enlarged veins are seen after a recent assault. Such forensic evidence is rarely found in children because of the usual...