Gastrointestinal
Acute torture-related symptoms have been described after having a foreign body in- serted into the anus. Lesions of the anus and rectum have been described as a conse- quence of the torture. The lesions give rise to pain and bleeding.constipation is often a secondary symptom to anal pain.
On examination of the anus, the following findings should be looked for and documented
Fissures tend to be non-specific findings as they may occur in a number of “nor- mal” situations (constipation, poor hy- giene). However, when seen in an acute situation (i.e. within 72 hours), fissures are a more specific finding and may be considered evidence of penetration.
Rectal tears with or without bleeding may be noted.
Disruption of the rural pattern may manifest as smooth fan-shaped scarring. When these scars are seen out of midline (i.e. not at 12 or 6 o’clock), they may be an indication of penetrating trauma.
Skin tags, which may be the result of healing trauma.
Purulent discharge from the anus. Cultures should be taken for gonorrhea and chlamydia in all cases of alleged rectal penetration, regardless of whether a discharge is noted.
Acute gastroduodenal haemorrhage has been reported by a small number of torture victim survivors, and may be explained by the extreme stress. Acute gastrointestinal symptoms such as abdominal pain, epigastric discomfort, di- arrhoea, vomiting, etc., are associated with torture and imprisonment. These symptoms must be considered to be of mixed etiology, in which mechanisms caused by the stressful situation may be a factor. Insufficient or unappetising food, restriction of liquids and lack of exercise may also be factors related to these gastrointestinal symptoms during imprisonment.
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