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Penetrating perineal injury in children is uncommon. However, the injury is serious and life-threatening with significant morbidity and mortality. We report an unusual case of a 13-year-old boy with an accidental perineal impalement injury by an iron rod, which pierced through the perineum and exited through the left loin, however with minimal external and internal injuries. Multiple vital organs in the pelvic space are vulnerable to damage in perineal impalement injury. Vital organ injury, amount of blood loss, and effectiveness of the
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