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Partial bowel obstruction in a 2-month-old child. A delayed diagnosis of anal abuse

Anna Aprile1, Eleonora Cesca, Giovanni Cecchetto

  • 1Department of Environmental Medicine and Public Health-Legal Medicine, University of Padua, Via Falloppio 50, Padua, Italy.

Forensic Science International
|September 22, 2009
PubMed

Insights

A 2-month-old boy experienced low bowel obstruction due to a foreign body. Diagnosis confirmed anal sexual abuse as the cause of this pediatric surgery case.

Area of Science:

  • Pediatric Surgery
  • Forensic Medicine
  • Gastroenterology

Background:

  • A 2-month-old infant presented with symptoms suggestive of low bowel obstruction.
  • Initial treatment at a peripheral hospital for presumed fecaloma included rectal wash-outs.
  • Persistent symptoms prompted transfer to a specialized pediatric surgery unit.

Observation:

  • Plain abdominal radiography revealed an unusual obstruction.
  • Rectoscopy and laparotomy were performed for definitive diagnosis and treatment.
  • A large vegetable foreign body was discovered lodged in the sigmoid colon.

Findings:

  • The foreign body's size (3 cm diameter, 7 cm length) and location confirmed it as the cause of the partial bowel obstruction.
  • The nature of the foreign body and its rectal impaction strongly suggested anal sexual abuse.

Implications:

  • This case underscores the critical need for considering non-accidental trauma, including sexual abuse, in pediatric surgical presentations.
  • Early and accurate diagnosis is crucial for timely intervention and management of pediatric bowel obstructions.
  • Healthcare providers must maintain a high index of suspicion for abuse in infants presenting with unexplained gastrointestinal symptoms.

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