di Luca Alessandro, Ricci Eleonora, Grassi Vincenzo M, Arena Vincenzo, Oliva Antonio
Institute of Public Health, Legal Medicine Section, Catholic University Medical School, Largo Francesco Vito, 1 - 00168, Rome, RM, Italy.
Institute of Pathological Anatomy, Catholic University Medical School, Largo Francesco Vito, 1 - 00168, Rome, RM, Italy.
J Forensic Sci. 2019 Jan;64(1):292-294. doi: 10.1111/1556-4029.13825. Epub 2018 May 24.
An 18-year-old female patient arrived at the emergency department complaining of abdominal pain and fullness after a heavy meal. Physical examination revealed she was filthy and cover in feces, and she experienced severe abdominal distension. She died in ED and a diagnostic autopsy examination was requested. At external examination, the pathologist observed a significant dilation of the anal sphincter and suspected sexual assault, thus alerting the Judicial Authority who assigned the case to our department for a forensic autopsy. During the autopsy, we observed anal orifice expansion without signs of violence; food was found in the pleural cavity. The stomach was hyper-distended and perforated at three different points as well as the diaphragm. The patient was suffering from anorexia nervosa with episodes of overeating followed by manual voiding of her feces from the anal cavity (thus explaining the anal dilatation). The forensic pathologists closed the case as an accidental death.
一名18岁女性患者因饱餐后出现腹痛和腹胀而前往急诊科就诊。体格检查发现她浑身脏兮兮的，身上沾满粪便，且有严重的腹胀。她在急诊科死亡，随后要求进行诊断性尸检。在外部检查时，病理学家观察到肛门括约肌明显扩张，怀疑存在性侵犯，于是通知了司法当局，司法当局将该案件交由我们部门进行法医尸检。在尸检过程中，我们观察到肛门开口扩张但无暴力迹象；在胸腔内发现了食物。胃高度扩张，在三个不同部位以及膈肌处穿孔。该患者患有神经性厌食症，有暴饮暴食发作，随后通过手动从肛门腔排出粪便（从而解释了肛门扩张的原因）。法医病理学家将此案判定为意外死亡。
