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28 year old gay identified white male left a bar late at night and awoke in a strange apartment, naked, duct tape around both ankles, arms, nausea, vomiting and severe rectal pain.  Patient reports that upon awakening he asked the two people in the apartment what had happened. He  was told that he had been using stimulants, was bound and restrained upside down and penetrated digitally only.  He has no memory of any of this.  Patient said he left the apartment and  immediately called the police. He was brought in by the paramedics with police.  On interview he notes that he has no memory of the night’s events and that he is in severe pain. He also reports that he has rectal bleeding.   Significant medical history includes  psychiatric disorder not otherwise specified,  allergy to bacitracin,  poor social support, and prior substance use.  Last thing he remember was having a fight with his boyfriend at a bar.  The patient agreed to speak with the police and respective members of SART.   He was medicated for pain control and for nausea likely secondary to his opiate side effect.  On  exam he appears to be in quite a of bit of discomfort and unable to lie on his back due to pain 8/10.  He has bruising to the right groin, left groin and right medial knee. He was noted to have a rapid heart rate on exam and remained so even after 2 liters of fluid for rehydration.  His oxygen saturation was noted to be 88-94%  on room air. This was concerning because it was known that he had been smoking stimulants.   The patient did not have a fever.  Patient had a slightly elevate white count.  He had an intermittent cough and decreased breath sounds on the left side. He noted that the cough started today.    Anosocope exam reveals a large laceration of the perianal fold at six o’clock with significant edema, bruising, and ecchymosis with serosanguinous discharge.    His rectal exam per anoscope was incomplete due to his inability to tolerate the anoscopic exam.  He had a chest x-ray revealing a multifocal pneumonia.   His clothing was collected for evidence. A forensic kit was completed including a toxicology screen, rectal swabs and photography per protocol.  All forensic evidence was collected per protocol with attention to chain of custody.

It was determined that the patient was likely a victim of drug facilitated sexual assault due to patient’s 5-6 hour memory loss.   A secondary diagnosis  was blunt force trauma to the anus and rectum with rectal laceration.   This injury was likely due to a source other than digital penetration.  Third, contusions to extremities and groin area bilaterally.  Fourth, high risk HIV exposure given rectal trauma. Fifth,  multifocal pneumonia.  Disposition. The patient was to remain in the department for hydration and likely antibiotics, pain management,  treatment for exposure to sexually transmitted infection including HIV exposure.  In addition the patient was given an appointment for psychosocial follow up.  Case highlights that men are indeed victims of sexual violence. Second, it is important to do a complete head to toe exam first to identify any life threatening injuries and to facilitate complete and accurate forensic documentation.    In this instance there is no identified perpetrator.  Case is pending with local law enforcement.

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