Service Medico-Judiciaire, Département Médecine Légale, Laboratoire National de Santé, 1, Rue Louis Rech 3555, Dudelange, Luxembourg.
Int J Legal Med. 2022 Mar;136(2):623-627. doi: 10.1007/s00414-021-02621-z. Epub 2021 May 31.
Examinations of young children for suspicions of sexual abuse are challenging for the involved medical specialists because the consequences of the interpretation of the findings can be severe and dramatic. A broad knowledge of differential diagnoses including rare pathologies like urethral prolapse and failure of the midline fusion of the perineum, known as perineal groove, is essential in order to avoid unnecessary diagnostics and treatment, prejudgment, and to reduce patient family's anxiety. We report two independent cases of girls aged 7 months and 5 years suffering from these rare pathologies, one presenting with painless lower genital tract bleeding, the other showing a lesion of the perineum as random finding during a neuropediatrician's consultation. In both cases, the pathologies were initially misdiagnosed as injuries due to sexual assault, and judicial investigation procedures were initiated. In this paper, the characteristic symptoms and morphology of urethral prolapse and perineal groove are presented to enhance the awareness of these pathologies among forensic experts and help to establish the correct diagnosis.
对涉及的医学专家来说，对有性虐待嫌疑的幼儿进行检查具有挑战性，因为这些发现的解释后果可能非常严重和戏剧性。为了避免不必要的诊断和治疗、预断，并减轻患者家庭的焦虑，广泛了解包括尿道膨出和会阴中线融合失败等罕见病理在内的鉴别诊断是至关重要的，会阴沟。我们报告了两名分别为 7 个月和 5 岁的女孩患有这些罕见病理的独立病例，一名出现无痛性下生殖道出血，另一名在神经科医生会诊时偶然发现会阴部位有病变。在这两种情况下，这些病变最初都被误诊为性侵犯造成的损伤，并启动了司法调查程序。本文介绍了尿道膨出和会阴沟的特征性症状和形态，以提高法医专家对这些病变的认识，并有助于确立正确的诊断。
