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      A fatal anal impalement

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          Abstract

          Dear Editor, Anal impalements are infrequent injuries, and generally involve only gastrointestinal, urinary or genital pelvic structures. They are rarely fatal. Only one previous fatal case was reported in the literature in 1995.[1] We report a rare case of fatal impalement, to our knowledge, the second one to be ever described in the literature. A 63-year-old man was admitted to the emergency department after an accident occurred in his garden. He presented a trans-anal impalement by a metallic rod [Figure 1] and a complex wound in the left-side thoracic wall [Figure 2]. On arrival, consciousness was preserved despite the low blood pressure. The only immediate therapy started was fluid resuscitation. Unfortunately, the patient died for a severe hemorrhagic shock. Figure 1 Entrance penetrating wound Figure 2 Exit penetrating wound with a severe lesion in the leftside sub-clavicular region Anal-perineal impalements are infrequent and potentially life-threatening injuries. Mortality rates are related to the severity of the trauma. Treatment requires a wide colo-proctological surgical expertise. A similar nonfatal case involving rectum, bladder, mesentery, liver, and right lung was recently published in 2012.[2] Most of the other reported cases are case series of pediatric patients victim of sexual abuse.[3] The surgical treatment of anal-perineal impalement can be problematic when serious vascular lesions have been caused, or multiple organs are involved; besides, uncomfortable sequelae such as urinary incontinence, anal sphincter dysfunction, and colonic diversion are frequent.[4] Our case highlights how complex the management of an anal impalement can be when the pelvis, abdomen, and thorax are involved simultaneously. For a correct management of such kind of lesions, a multidisciplinary approach to deal with the various injuries is needed, and the penetrating object must not be displaced until the surgical procedure has not begun. Novel approaches have been suggested, for example, in a recent case, authors report the successful implementation of a laparoscopic approach for a pediatric impalement injury.[5]

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          Fatal anorectal injuries: a series of four cases.

          Anorectal injuries associated with sexual practices have become more frequently reported in the last decade. Although anorectal injuries are commonly reported in cases of sexual abuse of children, fatalities are very rare. In this series of cases, we report a case of fatal child abuse resulting from anal intercourse. In addition, there are two cases of death in females as a result of heterosexual "fisting" or "handballing." The fourth case of the series is that of a homicidal injury produced by rectal impalement with a 31 inch length of threaded pipe.
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            Surgical management of colorectal injuries: colostomy or primary repair?

            Several factors have been considered important for the decision between diversion and primary repair in the surgical management of colorectal injuries. The aim of this study is to clarify whether patients with colorectal injuries need diversion or not.
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              Perineal impalements in children: distinguishing accident from abuse.

              Perineal impalements are uncommon and potentially life-threatening injuries. Medical providers must evaluate the risk of child abuse in all cases of genital or anal trauma. Determination of abuse depends on medical assessment of the mechanism of injury and statements by the child and witnesses, and may require collaboration with police or child protection agencies for scene investigation.
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                Author and article information

                Journal
                J Emerg Trauma Shock
                J Emerg Trauma Shock
                JETS
                Journal of Emergencies, Trauma, and Shock
                Medknow Publications & Media Pvt Ltd (India )
                0974-2700
                0974-519X
                Jan-Mar 2016
                : 9
                : 1
                : 45
                Affiliations
                [1]Department of Human Pathology “Gaetano Barresi”, University Hospital of Messina, 98125 Messina, Italy E-mail: famafausto@ 123456yahoo.it
                Article
                JETS-9-45
                10.4103/0974-2700.161660
                4766769
                26957831
                473f1682-00f8-4544-b7f4-a1d966e17c6b
                Copyright: © Journal of Emergencies, Trauma, and Shock

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Emergency medicine & Trauma
                Emergency medicine & Trauma

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