Unusual Foreign Body in a Child with Private Part Bleeding

When it comes to kid, you always need to think ahead. The experimental and wandering mind of kid can take any leap while discovering and unravelling surroundings.

History taking is a perplexing task as they are not going to admit the wrong doings as per human notion of not getting revealed publicly and on parents front the arguments are always being on the naive side and many a times deceptive and forcing you to loose the track.

Any how we have to respect all forms of human emotions and yet not boggled with what goes in our mind. The D/D s should be on...

INDEX CASE

4 years Female with history of blood stain in undergarments for 2 months associated with foul smell, itching in private part.

No history of fever, clear urine.

No significant history of trauma or any physical abuse.

Anxious parents but very concerned and empathetic.

INDEX CASE

• The underpants with dried serosanguinous stain.
• Perineum normal looking ( No sign of any injury: scratch, laceration, hematoma , swelling, erythema)
• Anal opening at normal predisposed side with no fissure( could cause blood stain in underpants)
• Introitus: Distinct Urethral and Vaginal opening seen.

Normal and healthy mucosa with mild watery secretion. Outside look was absolutely normal.

Probed gently after consent and to the UTTER SURPRISE

RETRIEVED from Vagina: AROUND 8 cm PLAY KNIFE.

TAKE HOME MESSAGE

• With kids the possibility of FOREIGN BODY should always be kept in mind as history given are often shaky.
• Bleeding from private part in small kids/ female needs a diligent and gentle approach as they have medicolegal bearing.
• Comprehensive talking with parents is the KEY as putting both in the SAME PAGE wins confidence and once the trust is built they slowly succumb to your commitment.
• Examination of private part in female child needs patience and done when both sides are ready.