Genitalia burn: accident or violence? Concerns that transcend injury treatment

OBJECTIVE: To describe a case of genital burn which raised the suspicion of maltreatment (sexual abuse and neglect by lack of supervision).CASE DESCRIPTION: An infant was taken to the Emergency Room of a pediatric hospital with an extensive burn in the vulva and perineum. The mother claimed the burn had been caused by a sodium-hydroxide-based product. However, the injury severity led to the suspicion of sexual abuse, which was then ruled out by a multidisciplinary team, based on the consistent report by the mother. Besides, the lesion type matched those caused by the chemical agent involved in the accident and the family context was evaluated and considered adequate. The patient had a favorable outcome and was discharged after four days of hospitalization. Outpatient follow-up during six months after the accident enabled the team to rule out neglect by lack of supervision.COMMENTS: Accidents and violence are frequent causes of physical injuries in children, and the differential diagnosis between them can be a challenge for healthcare workers, especially in rare clinical conditions involving patients who cannot speak for themselves. The involvement of a multidisciplinary trained team helps to have an adequate approach, ensuring child protection and developing a bond with the family; the latter is essential for a continued patient follow-up.

研究目的：报道1例疑似虐待（含性虐待及监管缺失型忽视）的生殖器烧伤病例。
病例详情：1名婴儿因外阴（vulva）及会阴部（perineum）大面积烧伤被送至儿科医院（pediatric hospital）的急诊室（Emergency Room）。患儿母亲称该烧伤由含氢氧化钠（sodium-hydroxide）的产品所致，但损伤的严重程度引发了性虐待的怀疑。随后多学科团队（multidisciplinary team）根据母亲的一致性陈述排除了该可能性。此外，皮损类型与此次事故中涉及的化学制剂所致损伤相符，且经评估家庭环境符合安全标准。患者预后良好，住院4天后出院。事故发生后6个月的门诊随访证实不存在监管缺失型忽视。
讨论：意外伤害与暴力是儿童躯体损伤的常见诱因，二者的鉴别诊断对医护人员而言常颇具挑战，尤其针对无法自行表述病情的罕见临床病例。由经过专业培训的多学科团队介入，有助于制定恰当的诊疗方案，保障儿童权益，并与家属建立信任联结；后者对于持续跟进患者随访至关重要。