POSTMORTEM PERIANAL FINDINGS IN CHILDREN

The postmortem finding of anal dilation or an exposed pectinate line i n children who have died under suspicious circumstances continues to r aise 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 a t 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%) Africa n-American, five (8%) Asian, three (5%) white Hispanic, and five (8%) other. Fifty-seven (88%) were in Tanner stage I of secondary sexual de velopment. Thirty-four (52%) died of natural causes, 26 (40%) from acc idental injuries, three (5%) from other causes, and four (6%) as a res ult of a homicide. Forty-eight subjects (74%) had some dilation of the anal sphincters. In 21 children (32%), the entire anal canal, includi ng the rectal ampulla, could be visualized. In another 21 (32%) subjec ts, the pectinate line was exposed. Only the outer portion of the anal canal opened in six children (10%), whereas 17 (26%) had no dilatatio n 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 lin e 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 t wo (3%). Blood was present in three (5%), and an abrasion was discover ed in one (2%). No fissures, lacerations, hemorrhoids, or scars were f ound 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 histo ry of a CNS injury at the time of death. It is suggested, finally, tha t anal dilatation alone cannot be used as a marker for prior sexual ab use and that exposure of the pectinate line should not be confused wit h tears or fissures of the anal verge. Further studies of children kno wn to have been sodomized prior to death are required.