title: Genital trauma and vaginal bleeding: is it a lapse of time issue? A case report of a prepubertal girl and review of the literature.
abstract: Child victims of sexual abuse may present with physical findings whose interpretation requires the most exhaustive evaluation and an accurate collection of a detailed history. Genital bleeding is usually considered as an acute sign, related to a trauma that occurred shortly before its appearance. We report a case of a 34-month-old child who was referred to the emergency room with a significant vaginal hemorrhage, originating from a wide laceration of the posterior fourchette, and a negative history for accidental trauma. The characteristics of the lesion, compared to the temporal evolution of the healing process, and the witnesses' depositions led us to assume that the time elapsed between the abusive event and the physical examination was longer in respect to what had appeared at the first sight. The judicial reconstruction of the events confirmed our assumption, allowing the charge of the right abuse perpetrator. As the literature regarding this eventuality is very poor, we report this case to stress the importance for physicians to consider that an active bleeding may be the manifestation of a trauma that occurred very long before.
authors.affiliation: Department of Molecular Medicine-Legal Medicine, University of Padua, Padua, Italy. marianna.russo82@gmail.com.
authors.forename: Marianna
authors.initials: M
authors.lastname: Russo
authors.affiliation: Child Abuse and Neglect Unit, Woman and Child Health Department, University of Padua, Padua, Italy.
authors.forename: Melissa
authors.initials: M
authors.lastname: Rosa-Rizzotto
authors.affiliation: A.S.L. TO 2, Turin, Italy.
authors.forename: Mariarosa
authors.initials: M
authors.lastname: Giolito
authors.affiliation: Child Abuse and Neglect Unit, Woman and Child Health Department, University of Padua, Padua, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ranzato
authors.affiliation: Child Abuse and Neglect Unit, Woman and Child Health Department, University of Padua, Padua, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Facchin
authors.affiliation: Department of Molecular Medicine-Legal Medicine, University of Padua, Padua, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Aprile
mesh_terms: D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D022125:Lacerations; D010808:Physical Examination; D013997:Time Factors; D014592:Uterine Hemorrhage / Q000209:etiology*; D014621:Vagina / Q000293:injuries*; D014844:Vulva / Q000293:injuries*; D014945:Wound Healing
keywords: Child sexual abuse; Injury timing; Vaginal bleeding; Wound healing