Sexual abuse or traffic accidental trauma? Analysis of a case

The authors present a complex case of a 5-year-old child who was involved in a traffic accident as a pedestrian hit by a car and reported widespread injuries mostly extrinsic at the anal level, suspected sexual abuse. As reflected in the literature (1), about 1 in 4 children are victims of abuse in their lifetime, and anogenital injuries are included in the clinical signs of suspected sexual abuse. In fact, we learn from the 2023 (2) update on the interpretation of clinical signs in cases of suspected child sexual abuse that a perianal laceration with exposure of the tissues underlying the dermis is suggestive of sexual abuse unless there is a plausible cause linking it to accidental trauma. In the present case, the medico-legal assessment and evaluation was carried out one month after the event and involved a forensic physician and pediatrician from the GAIA (Gruppo Abusi Infanzia e adolescenza) service at IRCCS Meyer. Anorectal or genital injury in children does not always have a clear and immediately well-framed diagnosis. It is essential that health care personnel consider various diagnostic hypotheses (sexual abuse, trauma, pathology, etc.) and be properly educated to manage and investigate such occurrences. In fact, even today, there is much confusion about how to frame these cases. Often sexual abuse is underdiagnosed while other times it is misdiagnosed, leading to dramatic consequences for both the child and the family.