Vaginorectal impalement injury in a 2-year-old child - caused by sexual abuse or an accident?

Anogenital impalement injuries are rarely encountered in clinical or forens ic practice. If seen in children and if incurred under suspect circumstance s, sexual abuse must be considered in the differential diagnosis. Here we d escribe the case of a 2-year-old girl admitted to hospital with a vaginorec tal impalement injury. According to the girl's parents, she had slipped in the bathroom and fallen onto the handle of an upright toilet bowl brush. Si nce a second slight anal injury was present, the parents' account appeared inconsistent. Therefore, physicians from the Institute of Legal Medicine we re consulted to investigate the possibility of underlying sexual abuse. Bec ause they could not rule out that the injuries could have been caused by se xual abuse, they recommended having the police immediately examine the site of the purported accident for evidence. The police and forensic investigat ions, however, verified the parents' account of an accidental injury. Thus, in this case, the initiation of a police inquiry which is not compulsory i n Germany even when sexual abuse is strongly suspected, led to the exonerat ion of the father. (C) 2001 Published by Elsevier Science Ireland Ltd.