Crohn's disease presenting as suspected abuse

Recent literature on child sexual abuse has attempted to define normal and abnormal anatomic findings on examination of the anogenital region. Hobbs and Wynn, studying a population of sexually abused children, found that one third of girls and two thirds of boys show signs of anal abuse. These signs include reddening and loss of normal anal fold patterns, anal dilatation, tears, swelling of the anal margin, and skin tags. Perianal soft-tissue findings, however, may be a variation of normal. McCann et al examined 267 children who had no histories of abuse and found 41% to have perianal erythema (mixed sexes) and 11 % (all girls) to have anterior anal skin tags.