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

Curcumin solid dispersion-loaded in situ hydrogels for local treatment of injured vaginal bacterial infection and improvement of vaginal wound healing

OBJECTIVES

Injured vaginal infection is detrimental to women. A curcumin hydrogel was studied for local treatment of injured vaginal infection.

METHODS

Curcumin solid dispersions (CSDs) were prepared from polyvinyl pyrrolidone and characterized by differential scanning calorimetry and an X-ray diffraction method. An in situ hydrogel CSD hydrogel (CSDG) was prepared with CSD/poloxamers and characterized. In vitro curcumin release and antibacterial effects of CSDs, CSDGs and curcumin were compared. The therapeutic effect of the CSDGs and Lincomycin/Lidocaine Gel was explored after intravaginal administration on the injured rat vaginal infection models.

KEY FINDINGS

Curcumin was amorphous in CSDs where curcumin rapidly released in simulated vaginal fluids. However, CSDGs showed sustained release. CSDGs quickly formed gels in the vagina. CSDGs showed high in vivo anti-Escherichia coli or Staphylococcus aureus effect though weak in vitro effect. The recovery of vaginal microenvironment and improvement of intravaginal Lactobacillus growth may be the major reason. Furthermore, CSDGs remarkably improved vaginal wound healing by alleviating inflammation and restoring vaginal epidermal tissues compared with the Lincomycin/Lidocaine Gel.

CONCLUSION

CSDGs are a promising topical formulation for local treatment of vaginal bacterial infection and improvement of vaginal wound healing.

A forensic evaluation of impalement injuries

Impalement injuries transfix a victim in an inescapable or helpless position. A study was undertaken at Forensic Science SA from 2002 to 2016 of all impalement deaths. There were six vehicle accidents (M:F=5:1; age 14-67 years, average age 38.5 years) involving impalements with a tree branch ( n=2; groin and chest), a metal pipe ( n=2; leg and head), a metal bridge railing (groin) and a metal fence post (chest). Two cases (both males, aged 47 and 18 years) had slipped on fences/gates, with impalements of the ankle and groin. A case of suicide (male, aged 80 years) was impaled through the head on a bolt fixed to the floor. A homicide case (male, aged 27 years) involved impalement through the chest by a spear from a spear gun. In certain cases (e.g. with anogenital injuries), differentiating accidental from inflicted impalement injuries may be difficult. In equivocal cases, adequate scene evaluations with photographic documentation are required prior to autopsy, ideally with the object available for examination.

Non-fatal impalement of the brain: A case report

We present a rare case of a non-fatal impalement injury of the brain. A 13-year-old boy was found in his classroom unconsciously lying on floor. His classmates reported that they had been playing, and throwing building bricks, when suddenly the boy collapsed. The emergency physician did not find significant injuries. Upon admission to a hospital, CT imaging revealed a "blood path" through the brain. After clinical forensic examination, an impalement injury was diagnosed, with the entry wound just below the left eyebrow. Eventually, the police presented a variety of pointers that were suspected to have caused the injury. Forensic trace analysis revealed human blood on one of the pointers, and subsequent STR analysis linked the blood to the injured boy. Confronted with the results of the forensic examination, the classmates admitted that they had been playing "sword fights" using the pointers, and that the boy had been hit during the game. The case illustrates the difficulties of diagnosing impalement injuries, and identifying the exact cause of the injury.

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

We present the case of an anal sexual abuse involving a 2-month-old boy, who was admitted to the Pediatric Surgery Unit of the University of Padua for low bowel obstruction. The infant had been already hospitalized for 3 days in a peripheral hospital and treated with daily rectal wash-outs for a fecaloma. Only after a careful interpretation of the plain abdominal radiograph, along with the performance of a rectoscopy and a laparotomy, a vegetable foreign body (about 3 cm in diameter and 7 cm in length) was discovered in the sigma. The morphology and dimensions of the foreign body, as well as its location, left no doubt about the etiology of the partial bowel obstruction, proving that it was clearly related to an anal sexual abuse.

Anorectal impalement in a pediatric patient with transanal evisceration of small bowel

Rectal injuries in the pediatric population are most often attributed to accidental falls on offending objects, sexual abuse, or blunt trauma. Anorectal impalement is a rare injury, and as a result, specific knowledge or experience on the treatment of this type of injury in children is sparse. The extent of injury is often difficult to assess. Mostly, therapeutical decisions are based on general knowledge in adults. We present a case of accidental anorectal impalement in a child by a fall on the handle of a toilet brush. The handle caused an anterior rupture of the intraperitoneal part of the rectum with subsequent transanal evisceration of several loops of small bowel.