Sexual abuse and incest. What can you do?

The problem of child sexual abuse is of increasing relevance to family physicians. Apart from the need to recognize and manage child victims and their families, it is important to be aware of the incidence and nature of the many sequelae of childhood sexual exploitation. Common signals include physical, psychosomatic, and psychiatric disorders. Some physicians must deal with their own childhood victimization if the best interests of their patients are to be served.

Heterotopic gastric mucosa in the gallbladder: a cause of chronic abdominal pain in a child.

A 12-year-old boy presented with a 7-year history of intermittent colicky epigastric pain. Serial abdominal ultrasound studies showed a contracted gallbladder, and single and double dose oral cholecystograms demonstrated nonfunction. All other investigation results were normal. At cholecystectomy, there was a fibrotic stricture at the junction of the gallbladder neck and cystic duct. The small, thin-walled gallbladder contained white bile. Histologically, the gallbladder was lined with normal mucous secreting columnar epithelium. The area of stricture showed diffuse fibrosis with islands of heterotopic gastric mucosa containing all gastric mucosal cell types. One year postoperatively, there have been no further episodes of abdominal pain. This is the seventh reported case of heterotopic gastric mucosa in the gallbladder of a child causing symptoms necessitating cholecystectomy. We recommend that a child with abdominal pain and a nonfunctioning gallbladder be considered for cholecystectomy even in the absence of cholelithiasis.

Sexual abuse of children: an update.

An increasing number of studies in the past decade have shown that sexual abuse of children is disturbingly common. The author reviews some of the more recent knowledge about the problem, with particular reference to medical implications. The incidence and distribution of the problem and the relative importance of the medical examination are reviewed, and the diagnostic significance of clinical presentations such as vulvovaginitis, recurrent urinary tract infection and masturbation is evaluated. The agents responsible for sexually transmitted diseases in abused children are reviewed. Many crucial psychosocial issues are raised in the evaluation and management of sexual abuse. The author discusses some aspects of abuse that are hard to confront, such as the possible pleasure of the child and the nonoffending role of the mother in cases of incest. Information from sources other than the medical literature on the characteristics of abusers, therapy and prevention is reviewed. The medical implications of the Badgley Report are also discussed.