Related Experiment Videos
Postmortem perianal findings in children
1Department of Pediatrics, University of California-Davis Medical Center, Sacramento 95817, USA.
Insights
Postmortem anal dilation and pectinate line exposure in children are not definitive signs of sexual abuse. Further research is needed to understand these findings in forensic pediatric cases.
Area of Science:
- Forensic Pathology
- Pediatric Medicine
- Child Abuse Investigation
Background:
- Postmortem anal dilation and exposed pectinate lines in children raise concerns about potential sexual abuse.
- Existing literature lacks comprehensive data on these findings in pediatric autopsies.
Purpose of the Study:
- To investigate the prevalence and characteristics of anal findings in deceased children.
- To determine if anal dilation or pectinate line exposure are reliable indicators of sexual abuse.
Main Methods:
- A multicenter, collaborative study involving 65 pediatric autopsies.
- Standardized protocols and photography were used to document anal findings.
- Data collected included demographics, cause of death, and detailed anal examination.
Main Results:
- 74% of subjects showed some anal sphincter dilation; 32% had exposed pectinate lines.
- Anal orifice size varied with age, applied traction, and CNS injury history.
- No fissures, lacerations, hemorrhoids, or scars were observed.
Conclusions:
- Anal dilation alone is not a sufficient marker for prior sexual abuse in children.
- Exposed pectinate lines should not be misidentified as anal verge tears or fissures.
- Further studies on children with confirmed prior sexual abuse are warranted.
Abstract:
The postmortem finding of anal dilation or an exposed pectinate line in children who have died under suspicious circumstances continues to raise the concern of possible sexual abuse. The following multicenter, collaborative study was designed to help address that question. Sixty-five subjects, ranging in age from birth to 17 years, were autopsied at three different sites. A standard protocol along with 35-mm cameras were used to record the results. Thirty-eight (58%) subjects were boys, and 27 (42%) were girls. Forty-two (65%) were white, 10 (15%) African-American, five (8%) Asian, three (5%) white Hispanic and five (8%) other. Fifty-seven (88%) were in Tanner stage I of secondary sexual development. Thirty-four (52%) died of natural causes, 26 (40%) from accidental injuries, three (5%) from other causes, and four (6%) as a result of a homicide. Forty-eight subjects (74%) had some dilation of the anal sphincters. In 21 children (32%), the entire anal canal, including the rectal ampulla, could be visualized. In another 21 (32%) subjects, the pectinate line was exposed. Only the outer portion of the anal canal opened in six children (10%), whereas 17 (26%) had no dilatation of the anus. Anal laxity led to flattened skin folds in 50 (77%), a shallow anal canal in 40 (62%), the exposure of both the pectinate line in 38 (59%), and the anal mucosa in 24 (37%). Venous congestion was present in 14 (22%), venous pooling in three (5%), erythema in six (9%), and increased pigmentation in eight (12%). Funneling was found in two (3%). Blood was present in three (5%), and an abrasion was discovered in one (2%). No fissures, lacerations, hemorrhoids, or scars were found in any of the children. Anal orifice size varied with the age of the child, the amount of traction applied to the buttocks, and a history of a CNS injury at the time of death. It is suggested, finally, that anal dilatation alone cannot be used a marker for prior sexual abuse and the exposure of the pectinate line should not be confused with tears or fissures of the anal verge. Further studies of children known to have been sodomized prior to death are required.