Trichobezoar in Vagina: Assessment for Child Sexual Abuse and Diagnostic Result of Forensic Science

Abstract

Vaginal discharge and bleeding in children require a through and thoughtful evaluation to diagnose the underlying problem including infections, sexual abuse, and vaginal foreign bodies. We report a 6-year-old girl presenting with bloody vaginal discharge, carefully evaluated for sexual abuse, and finally diagnosed as a vaginal foreign body after vaginoscopy. A rolling hair ball was extracted from the vagina and was diagnosed as trichobezoar pathologically without any endo-ecto-mesodermal residual tissue. The hair ball was genetically detected and diagnosed to belong herself by containing no foreign structure. Child sexual abuse was ruled out by forensic interview at CAC and report of forensic science that reported genetic structure belonging to the child. Medicolegal assessment helped in final diagnosis to exclude child sexual abuse.

Polyembolokoilamania in Child Sexual Abuse

“…This is the single largest series that has purposefully evaluated the physical harm that abuse with an object may inflict on a sexually abused child. Some published populations include child victims describing the introduction of an anal or genital foreign body, but do not specifically link the physical examination findings associated with that form of contact 5,34 . Kellogg et al 7 describe a series of adolescents reporting recent or current pregnancy at the time of their sexual abuse examination, two of whom had recently undergone vaginal instrumentation for dilation and curettage; neither of those two patients had abnormal examination findings.…”

“…In review of the published literature, there was a significant variation in the approach to the evaluation of a pediatric VFB. Sexual abuse was mentioned as part of the differential diagnosis or discussion most frequently for these girls when the chief complaint involved reports of vaginal discharge, or less commonly, abdominal pain 25–30,32,34,36–41,43–52,55,57,58,63 . Sexual abuse was a later consideration in the diagnoses of anorectal foreign bodies for the 3 younger male patients described.…”

“…Some published populations include child victims describing the introduction of an anal or genital foreign body, but do not specifically link the physical examination findings associated with that form of contact. 5,34 Kellogg et al 7 describe a series of adolescents reporting recent or current pregnancy at the time of their sexual abuse examination, two of whom FIGURE 1. Normal examinations.…”

“…Sexual abuse was mentioned as part of the differential diagnosis or discussion most frequently for these girls when the chief complaint involved reports of vaginal discharge, or less commonly, abdominal pain. [25][26][27][28][29][30]32,34,[36][37][38][39][40][41][43][44][45][46][47][48][49][50][51][52]55,57,58,63 Sexual abuse was a later consideration in the diagnoses of anorectal foreign bodies for the 3 younger male patients described. For these boys, the history of present illness was revisited upon detecting the foreign objects in the workup for their chief complaints of abdominal pain.…”