Fatal Anorectal Trauma in the Setting of Sexual Assault

Abstract

Homicides exclusively due to genital trauma have not been widely reported, and anorectal trauma in sexual assaults is uncommon. We describe a case of a 45-year-old white woman who sustained devastating homicidal colorectal trauma that served as a primary cause of death in the setting of rape. Our patient sustained a 15-cm laceration of the anterior rectal wall and ultimately died of peritonitis and sepsis. Death from rectal perforation and sepsis in the setting of sexual assault is rare and has only been documented in 3 other cases, 2 pediatric patients and 1 elderly debilitated patient. Other representative and unique methods of perforation are reviewed along with a brief discussion of the development of peritonitis after perforating colorectal trauma.

Fatal anogenital exenteration of the intestine

“…There are several case reports in the literature that broach the issue of penetration injuries of the vagina or anus by inserting the hand (“fisting”) or objects [ 13 – 27 ]. Sporadic deaths after fisting have also been described [ 28 – 30 ], but in those cases, injuries to vessels, such as the uterine artery, with consecutive blood loss [ 31 ] or peritonitis/sepsis after traumatic injury to the colon [ 29 ] have occurred. Such extreme violence as in our case, with tearing out almost the entire small intestine and large parts of the colon (including those parts located retroperitoneally) during fisting, is extremely unusual.…”

Fatal Rectal Perforation Following Boar-to-Boar Mounting

“…14 Furthermore, the location of both tears on the ventral side of the rectum is typical in human anorectal trauma due to sexual assault. 7 In contrast, equine rectal tears, which are most commonly iatrogenic (associated with rectal examination), usually develop on the dorsal side of the rectum at a species-specific weak point in the tunica muscularis. 6 The adrenocortical hemorrhage was attributed to sepsis (Waterhouse-Friedrichsen syndrome).…”

Fisting intimacy: The sexual scripting of intimacy in gay men’s anal fisting

“…Academic work on fisting has been largely dominated by clinically-oriented medicoforensic case studies which focus on the sexual injuries, sexually transmitted diseases, and fatal sexual trauma, in which fisting has been implicated (Cappelletti et al, 2017;de Bakker & Bruin, 2012;Irizarry & Gottesman, 1996;Kim et al, 2013;Lowry & Williams, 1983;Orr et al, 1995;Preuss et al, 2008;Reay & Eisele, 1983;Reiner, 1984;Shook et al, 1985;Short, 2016;Sohn et al, 1977;Spears et al,1995;Torre, 1987). Although some of this work has acknowledged that non-consent (Cappelletti et al, 2016), inexperience (Navin, 1981), intoxication (Cohen et al, 2004), or violence (Kovelman et al, 2010) were determining factors in the cases under study, much of this research has come to reiteratively associate fisting with harm and violence, discursively circumscribing it as inherently risky and dangerous.…”