University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, Michigan.
Section of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio.
J Pediatr Adolesc Gynecol. 2022 Oct;35(5):546-551. doi: 10.1016/j.jpag.2022.03.006. Epub 2022 Mar 28.
Traumatic non-obstetrical hematomas of the vulva are rare, and most reports only involve adult patients. There are no data on presentation, management, and outcomes from either conservative or surgical management in pediatric and adolescent patients. The objective of this project was to compare the etiology, treatment, and outcomes of traumatic vulvar hematomas occurring in premenarchal and postmenarchal young women.
A retrospective chart review was performed on females aged 0-24 years seen at a tertiary care academic center using ICD 9 and 10 codes for traumatic vulvar hematoma from 2006-2019. Data describing their clinical presentation and course were collected. IRB approval was obtained.
Twenty patients, aged 3-23 years (median age of 13.5 years) were identified. All 8 premenarchal patients presented with a straddle injury, whereas only 50% of postmenarchal patients were found to have a straddle injury. Other etiologies among postmenarchal patients included consensual sexual intercourse and recent vulvar surgery. Hematoma diameter ranged from 1-3 cm in premenarchal patients and 0.4-7 cm in postmenarchal patients. Associated perineal lacerations were reported in 50% of the premenarchal girls and 8% of postmenarchal young women. Of the 8 premenarchal patients, 5 were managed conservatively, and 3 were taken to the operating room for repair of perineal lacerations; 1 patient also underwent evacuation of a 3-cm hematoma. Of the 12 postmenarchal patients, 5 had surgical intervention, 2 for pain secondary to large 7-cm hematomas and 3 for suspected vulvar abscesses, which were identified as hematomas after drainage. One patient in each group required a Foley catheter for comfort. Two postmenarchal patients required a second surgery for further wound management. One premenarchal patient with surgical treatment required a follow-up exam under anesthesia. Four patients were admitted for pain and postoperative observation, 1 of whom was premenarchal. Eleven patients were seen for follow-up, and 10 were doing well. One postmenarchal patient in the conservative management group returned to the Emergency Department with continued pain 10 days later.
In this study that examined traumatic vulvar hematomas in premenarchal and postmenarchal young women, the only mechanism of injury in premenarchal girls was straddle injury, and surgical intervention was usually needed only for repair of perineal lacerations, not a primary hematoma. In the postmenarchal patients, surgical intervention was undertaken for larger hematomas and suspected vulvar abscesses. Our study suggests that most hematomas up to 3 cm in premenarchal patients and up to 6 cm in postmenarchal patients can be managed conservatively.
外阴创伤性非产科血肿较为罕见，大多数报道仅涉及成年患者。在儿科和青少年患者中，关于保守或手术治疗的表现、管理和结果尚无数据。本项目的目的是比较青春期前和青春期后年轻女性发生的创伤性外阴血肿的病因、治疗和结局。
使用 ICD-9 和 ICD-10 代码，对 2006 年至 2019 年在一家三级学术中心就诊的 0-24 岁女性患者进行回顾性图表审查，以确定创伤性外阴血肿。收集描述其临床表现和病程的数据。获得了 IRB 的批准。
确定了 20 名年龄 3-23 岁（中位年龄 13.5 岁）的患者。所有 8 名青春期前患者均出现骑跨伤，而只有 50%的青春期后患者发现骑跨伤。青春期后患者的其他病因包括双方同意的性行为和最近的外阴手术。血肿直径在青春期前患者中为 1-3cm，在青春期后患者中为 0.4-7cm。50%的青春期前女孩和 8%的青春期后年轻女性报告有会阴裂伤。8 名青春期前患者中，5 名接受保守治疗，3 名因会阴裂伤接受手术修复；1 名患者还接受了 3cm 血肿的引流。12 名青春期后患者中，5 名接受了手术干预，2 名因 7cm 大血肿引起的疼痛，3 名因疑似外阴脓肿而接受手术干预，引流后发现是血肿。在每个组中，1 名患者因舒适度需要 Foley 导管。2 名青春期后患者因进一步伤口管理需要再次手术。1 名接受手术治疗的青春期前患者需要在全身麻醉下进行后续检查。4 名患者因疼痛和术后观察入院，其中 1 名是青春期前患者。11 名患者接受了随访，10 名患者情况良好。1 名接受保守治疗的青春期后患者在 10 天后因持续疼痛返回急诊科。
在这项研究中，我们研究了青春期前和青春期后年轻女性的创伤性外阴血肿，青春期前女孩唯一的损伤机制是骑跨伤，通常仅需要手术修复会阴裂伤，而不是原发性血肿。在青春期后患者中，手术干预是针对较大血肿和疑似外阴脓肿进行的。我们的研究表明，大多数血肿在青春期前患者中可达 3cm，在青春期后患者中可达 6cm，可以保守治疗。
