Management of Anorectal Avulsion in Children: A Retrospective Cohort Study.

Abstract

Aim: To introduce our experience in the management of anorectal avulsion in children and propose feasible treatment procedures for anorectal avulsion.

Methods: We conducted a retrospective cohort study of 20 patients (13 males, 7 females) with anorectal trauma at Beijing Children's Hospital from 2020 to 2024. Patients with anorectal avulsion were selected for a detailed review, including management process and prognosis, and were compared with patients with anorectal laceration.

Results: Of the patients, 7 (7/20, 35.0%) were identified with anorectal laceration, 13 (13/20, 65.0%) had anorectal avulsion, and the mean age was 7.4 ± 3.5 years. Traffic accidents (11/20, 55.0%) were the major cause. Compared with patients with anorectal laceration, patients with anorectal avulsion had a higher average ISS ([26.0 (16.0-36.0) vs 4.0 (0.0-21.0)], p < 0.001) with unstable vital signs ([11/13, 84.6%] vs [0/7, 0.0%], p < 0.001). These patients were more likely to require diversion ostomy during primary management ([9/13, 69.2%] vs [1/7, 14.3%], p = 0.029) but had a higher probability of postoperative complications ([12/13, 92.3%] vs [0/7, 0.0%], p < 0.001). Twelve patients with anorectal avulsion (12/13, 92.3%) underwent anorectal manometry before anorectal reconstruction, except for 1 patient who had anal closure after primary repair. All patients underwent anal sphincter identification by muscle stimulator, and 10 (10/13, 76.9%) underwent sphincter repair and anoplasty again. Anorectal manometry before stoma closure showed that the maximum anal squeeze pressure of patients with anorectal avulsion were higher than those before anorectal reconstruction, and the duration of squeeze was also prolonged. At follow-up, patients with anorectal avulsion had undergone an average of 5.0 (2.0-14.0) operations, much more than patients with anorectal laceration ([1.0 (1.0-4.0)], p < 0.001), and 3 patients had not closed the stoma. The median bowel function score was significantly lower in patients with anorectal avulsion than in patients with anorectal laceration ([16.0 (10.0-20.0) vs All: 20], p = 0.008).

Conclusion: Patients with anorectal avulsion require multiple evaluations and repairs to achieve a reasonable bowel function. It is recommended that further experience is accumulated to improve the management process.

Level of evidence: Level III.