title: Vaginorectal impalement injury in a 2-year-old child--caused by sexual abuse or an accident?
abstract: Anogenital impalement injuries are rarely encountered in clinical or forensic practice. If seen in children and if incurred under suspect circumstances, sexual abuse must be considered in the differential diagnosis. Here we describe the case of a 2-year-old girl admitted to hospital with a vaginorectal impalement injury. According to the girl's parents, she had slipped in the bathroom and fallen onto the handle of an upright toilet bowl brush. Since a second slight anal injury was present, the parents' account appeared inconsistent. Therefore, physicians from the Institute of Legal Medicine were consulted to investigate the possibility of underlying sexual abuse. Because they could not rule out that the injuries could have been caused by sexual abuse, they recommended having the police immediately examine the site of the purported accident for evidence. The police and forensic investigations, however, verified the parents' account of an accidental injury. Thus, in this case, the initiation of a police inquiry, which is not compulsory in Germany even when sexual abuse is strongly suspected, led to the exoneration of the father.
authors.affiliation: Hanover Medical School, Institute of Legal Medicine, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. schroeder.guenter@mh-hannover.de
authors.forename: T
authors.initials: T
authors.lastname: Rothämel
authors.forename: D
authors.initials: D
authors.lastname: Bürger
authors.forename: A S
authors.initials: AS
authors.lastname: Debertin
authors.forename: W J
authors.initials: WJ
authors.lastname: Kleemann
mesh_terms: D001003:Anal Canal / Q000293:injuries*; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005554:Forensic Medicine; D006794:Household Articles; D006801:Humans; D014621:Vagina / Q000293:injuries*; D014947:Wounds and Injuries / Q000209:etiology