title: Trans-metatarsal amputation as a complication of child sexual abuse.
abstract: A case of chronic physical abuse and acute sexual abuse via anal penetration complicated with disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and subsequent bilateral trans-metatarsal amputation is reported. A 13-year-old male presented with old cigarette burns on his chest and acute anal laceration. Four days after laceration repair, he developed DIC and ARDS. The child had to undergo bilateral trans-metatarsal amputation. Due to the systemic defects of the child protection system in Turkey, sexual and physical abuse were recognized by medical personnel 45 days after admission, child protective services never got involved, and prosecution failed to punish the perpetrator(s) of this extreme victimization. This is the only reported case of bilateral trans-metatarsal amputation due to sexual abuse complicated with DIC and ARDS. Social and medico-legal management of sexual abuse is suboptimal in Turkey. Within that context, professionals should be trained on how to recognize, assess, diagnose and manage victims of child abuse and neglect.
authors.affiliation: Department of Forensic Medicine, School of Medicine, Dokuz Eylül University, Izmir 35300, Turkey. erdem.ozkara@deu.edu.tr
authors.forename: Erdem
authors.initials: E
authors.lastname: Ozkara
authors.forename: Vasfi
authors.initials: V
authors.lastname: Karatosun
authors.forename: Izge
authors.initials: I
authors.lastname: Gunal
authors.forename: Resmiye
authors.initials: R
authors.lastname: Oral
mesh_terms: D000293:Adolescent; D000671:Amputation, Surgical; D001003:Anal Canal / Q000293:injuries; D002650:Child Abuse, Sexual; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005528:Foot / Q000098:blood supply* / Q000473:pathology*; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000601:surgery; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D009336:Necrosis; D011183:Postoperative Complications; D012128:Respiratory Distress Syndrome / Q000209:etiology