Graeme J. Pitcher

Infant rape in South Africa.

Records from the Crime Information Management Centre of the South African Police Force indicate that in 1999 221072 sexual offences were committed against persons aged under 17 years. Child and adolescent rape is a problem worldwide and a growing concern in sub-Saharan Africa. In addition there also seems to be an increase in the amount of infant rape (IR) which is perpetrated on children under the age of 1 year old. The motivations for IR are complex and seem to have several striking features. To penetrate the infants vagina the perpetrators create a common channel between the vagina and anal canal by insertion of an implement analogous to mutilation by introcision. Indeed rape in this manner can be fatal to children as this may cause death due to hemorrhage or abdominal sepsis. State hospitals are not funded to provide antiretroviral prophylaxis in IR cases because of the state’s contention that the interventions efficacy is not proven yet. Furthermore the theory behind IR is related to the myth that intercourse with virgin infants will enable the perpetrator to rid himself of sexually transmitted diseases. Failure of the political leadership to acknowledge HIV/AIDS infections has been the ground of such bizarre and dangerous myths to take root. Hence community educational programs must be expanded and appropriately targeted to populations at risk.

Pediatric renal transplantation in a South African teaching hospital: A 20-year perspective

Abstract:u2002 Introduction:u2002 Renal transplantation is established as the standard of care for end‐stage renal failure (ESRF) in the developed world. In emerging nations, the appropriateness of such costly interventions has been questioned. We undertook an analysis of all renal transplants undertaken under the care of the pediatric nephrology service at the Johannesburg Hospital, South Africa, in order to establish the outcomes of a transplantation service in a resource‐constrained environment in a developing country.

Bowel obstruction in an infant with AIDS

AIDS accounted for approximately one quarter of all deaths in South Africa in 2000 and has become the country’s single biggest cause of death.1 Paediatric HIV infection is now a common cause of admission to hospital and a major contributor to childhood mortality.2 A recent study reported that 60% of admissions to an academic hospital in Durban (Kwa-Zulu Natal) were infected with HIV.3 We report a case of intestinal obstruction in an infant with HIV infection, the cause of which was only diagnosed at postmortem examination.nnA 2 month old female presented with a three day history of constipation, anorexia, and progressive abdominal distension. The child had been a full term, normal vaginal delivery to an otherwise well mother. Examination revealed a mildly dehydrated baby with a grossly distended but soft abdomen; no masses were palpable. Abdominal x ray examinationshowed multiple distended loops of small bowel, ultrasound examination was non-diagnostic, and contrast enema revealed a normal colon but was unable to adequately define the ileocaecal region. Repeat plain abdominal films 24 hours later showed features consistent with distal small bowel obstruction.nnAt laparotomy, an inflammatory stricture …

Fetal extraperitoneal rectal perforation: a rare neonatal emergency

PURPOSEnIntraperitoneal bowel perforation may occur in utero as a result of a variety of abnormalities and typically results in sterile meconium ascites, pseudocysts, and/or calcification in the fetus. On the other hand, extraperitoneal bowel perforation in intrauterine life is extremely rare. The object of this report is to present our experience of prenatal extraperitoneal rectal perforation, defining the clinical presentation, management, and progress.nnnMETHODS AND MATERIALSnNine babies who were identified from 2 centers in the Republic of South Africa with fetal extraperitoneal rectal perforation are presented. The details of these babies were obtained retrospectively from the case notes.nnnRESULTSnAll patients presented at or shortly after birth with air and meconium tracking below the pelvic floor manifesting as either an expanding, meconium-stained aerocele or with perirectal spreading sepsis. Where abdominal signs were present, laparotomy confirmed the extension of the meconium perforation into the peritoneal cavity. Management was by diverting colostomy, drainage of the perineal collection, and supportive therapy. A posterior approach to the rectum and excision of a fibrotic section of the lower rectal wall was performed in one case. One case developed rectal stenosis that was treated by dilatation before colostomy closure. In all the other cases, digital examination performed before colostomy closure ruled out significant narrowing. There was no mortality, and the site of the rectal perforation healed in all cases to leave good anorectal function after treatment.nnnCONCLUSIONSnFetal extraperitoneal perforation is extremely rare, but the clinical features are easily recognizable, and when appropriate therapy is instituted, the outcome is likely to be good with normal anorectal function to be expected in the long-term. The exact cause of the condition is unknown.

Formalin treatment of refractory hemorrhagic cystitis

Severe hemorrhagic cystitis can be a devastating complication of chemotherapy. Intravesical formalin may obviate the need for radical surgery in the face of failure of other conservative measures. Open instillation is favored in order to reduce the risk of complications.

Appendico-cutaneous fistula in cystic fibrosis

Appendico-cutaneous fistulae are rare. We describe a 12-year-old girl with cystic fibrosis (CF) and a chronically draining sinus in the right iliac fossa, found to be a primary appendico-cutaneous fistula. Misdiagnosis of right iliac fossa pain in patients with CF and the preponderance of complicated disease frequently lead to manifestations of appendicitis rarely seen in usual clinical practice.