Spotting in una bambina di sei anni
ID: mg|2015|06|01 (in progress)
S. è una simpaticissima bambina di 6 anni che da circa dieci giorni presenta perdite ematiche vaginali
All’ispezione i genitali esterni non presentano infiammazione, vedo una piccola (2–3 mm) formazione biancastra appena sopra l’imene. Per differenziare tra corpo estraneo/secrezione e lesione la tocco con un tampone ma si sposta più internamente.
Esclusa una lesione ho alto sospetto di corpo estraneo (carta igienica?) prescrivo amoxi-clavulanico. La rivisito quindi io dopo 5 giorni di antibiotico, le perdite persistono anche se diminuite.
intanto ho un po’ studiato cosa fare in self-help:
- posizioni per l’esame genitale in bambina prepubere
- come estrarre un piccolo corpo estraneo: tampone oppure irrigazione vaginale
Esame genitale in bambina
“Genital examination of the preadolescent female is best conducted with the patient either in the supine position with legs in a frog-like position, flexed and abducted at knees and hips, or with the patient prone in a knee-chest position.”
“Most children over three years of age can cooperate for prone knee-chest examination. The keys to successful visualization of the vaginal vault using this position are adequate lateral and cephalad retraction of the child’s buttocks and labia majora (accomplished by a parent or assistant) and adequate relaxation of the abdominal muscles to ensure that air enters the vaginal vault.”
Prone in a knee-chest position
tratta da uptodate (link)
tratta da uptodate
Strumento per visualizzare: un otoscopio
“This position also facilitates visualization of the vaginal canal. Vaginal foreign bodies and/or the cervix also can be visualized when a child is in this position.
A hand-held otoscope can be used to provide a small field of light and magnification, and is readily available in most exam rooms. The lens of an otoscope provides a reasonable degree of magnification of suspicious areas”
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Come estrarre piccoli corpi estranei vaginali
“FOREIGN BODY — Foreign bodies in children can cause acute and chronic recurrent vulvovaginitis. Chronic vaginal discharge, intermittent bleeding or spotting, and/or a foul smelling odor are the usual clinical manifestations. Toilet paper is the most common foreign body found in the vaginas of children; small toys, hair bands, and paper clips are also common. The foreign body can often be removed by a calgi swab (for toilet paper) or with irrigation with warmed fluid”
