Acquired Rectovaginal Fistula and Faecal Incontinence Following Sexual Assault in a 4-Year-Old Girl

Background: Child Sexual Abuse (CSA) is a crime against children. It is largely under-reported and commonly goes unpunished in our society.

Case report: The patient is a 4-year-old girl who presented to our emergency paediatric unit with 14 hours duration of faecal incontinence following sexual assault by her landlord’s son. She also complains of pelvic pain and difficulty in walking. The landlords’s son forced his penis into her anus and inserted his fingers through her vagina.

On examination of her anal region, there was anal sphincter tear at six 0’ clock, extending exteriorly to the right measuring 1 cm long and 0.5 cm deep with a rectovaginal fistula. Vaginal examination revealed minor laceration and excoriation on the right lateral wall and floor of the vagina, with mild bleeding. She had a left hymenal tear at the lower aspect and a vagina floor tear. Results of urine microscopy culture and sensitivity (MCS) revealed white blood counts (WBC) 2+, leucocytes 2+, epithelial cells+, Staphylococcus aureus was isolated which was sensityive to amoxiciilin.

The child was resuscitated and given antibiotics and analgesics and prophylactic antiretroviral drugs. She had a perineal tear repair by the paediatric surgeon. She was placed on sitz bath and she responded well with good healing and recovery. She was discharged after 2 weeks on admission and came back for follow-up.

This report highlights the management of a case of rectovaginal fistula in a child as a result of sexual assault.