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Är det här normalt?

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På sådana här sidor tenderer det ofta att komma en massa frågor av typen jag har det här problemet... är jag normal. Svaret blir nästan alltid att ja du är helt normal. Tänkte testa en sådan tråd själv.

Nedanstående text är en artikel i en tidskrift i traumamedicin (International Journal of Care - Injured) där forskare kan redovisa resultat från sin forskning. Ofta rapporterar dom om patientfall dom haft som varit intressanta, så också i detta fallet. Vad tror ni om patienten dom skriver om och det han gjort för att hamna på en kirurgavdelning? Trevlig läsning!

Injury, Int. J. Care Injured 33 (2002) 367–368

Case report
Zoophilia: a rare cause of traumatic injury to the rectum
Gueno K. Kirov a, Julian E. Losanoff b,∗, Kirien T. Kjossev b
a Department of Surgery, Central Clinical Hospital, Sofia, Bulgaria
b Department of Surgery, Military Medical Academy, Sofia, Bulgaria
Accepted 18 October 2001

1. Introduction
Sexual contacts with animals (zoophilia, bestiality) are rarely reported. The second well-documented case of life-threatening rectal injury resulting from anal intercourse with a boar is reported herein.

2. Case report
A 62-year-old farmer presented with generalized abdominal pain of eight hour’s duration. Past medical history was negative. Physical examination revealed marked abdominal distension with diffuse rebound. Digital rectal examination was unremarkable. Chest and abdominal X-ray film revealed free gas below the diaphragm and multiple gas-fluid levels consistent with paralytic ileus. Laboratory findings were significant for peripheral leukocytosis of 16,500mm3. Laparotomy revealed diffuse feculent peritonitis and a 0.5 cm anterior tear of the rectum located 5 cm above the pelvic peritoneal reflection. The edges of the tear were ragged but without necrosis. No other pathology or foreign body was found. The abdomen was cleaned and the perforation closed. Intraoperative anoscopy and sigmoidoscopy were unremarkable except for several minute mucosal hematomas on the luminal aspect of the tear. A diverting transverse colostomy was constructed.
The abdomen was irrigated copiously with warm saline, drained and closed in layers. Post-operative treatment consisted
of nasogastric suction, total parenteral nutrition and broad-spectrum antibiotics. The patient recovered uneventfully.

3. Discussion
A non-erected adult boar’s penis measures between 450 [1] and 620mm [2] in length. It has no glans; the most distal part is twisted spirally and has a curved pointed tip (Fig. 1). The right corpus cavernosum is stronger than the left [2]. This, together with the repeated contraction and relaxation of an asymmetrically attached retractor penis muscle [3] accounts for repeated forward and backward twisting motion at copulation, despite the lack of obvious activity on the part of the boar. One contraction of the retractor penis muscle causes the distal penis to undergo a double twist [2]. For ejaculation to occur, the penis must engage in the thick-walled, spiral, transverse ridges of the sow’s vagina and become finally “locked” in the cervix by further erection [4]. The extra length of erected penis that repeatedly enters the sow’s vagina is said to be at least 160mm [2]. We hypothesize that the boar’s penis “hooked” a mucosal fold of rectum with its pointed curved tip during twisting forward motion. A transmural tear occurred when pressure exceeded the rectal wall compliance at a fixed point of contact. Zoophilia (bestiality) is rarely reported in the medical literature. We identified only one analogous report of sexual intercourse with a boar. In 1976, Blondel described the case of a 46-year-old farmer who underwent surgery for peritonitis 16 h after intercourse. A single perforation of the sigmoid colon was found and exteriorized. The abdomen was lavaged and closed, with favorable postoperative course [5].

Our experience and literature data suggest that although rare, zoophilia may be a rare etiology of colonic trauma. Surgical
treatment must be prompt and based on principles applicable to any other colonic injury.

The authors thank Mr. C.Trenton Boyd, BS, MA, AHIP, Veterinary Medical Librarian, for his bibliographical assistance.

[1] Sisson S. Urogenital system. In: Getty R, editor, The anatomy of the domestic animals. 5th ed. Philadelphia: Saunders; 1975. p. 1297.
[2] Schummer A, Giessen B, Vollmerhaus B. Harn- und Geschlechtsapparat. In: Nickel R, Schummer A, Seiferle E, editors. Lehrbuch
der Anatomie der Haustiere. 7th ed. Berlin: Blackwell; 1995. p. 300.
[3] Sack WO. Essentials of pig anatomy. Ithaca: Veterinary Textbooks, 1982. p. 49.
[4] Roberts SJ. Veterinary obstetrics and genital diseases (Theriogenology). Woodstock: Published by the author, 1986. p. 771.
[5] Blondel Ph. Perforations digestives d’etiologie insolite: Deux cas. Nouv Presse Med 1976;5:915