Introduction: A rare event of fatal sexual assault by the insertion of a wooden rod through the anus to the upper chest is reported. Examination of the body at the scene did not raise any suspicion of assault while the subsequent autopsy revealed findings that changed the assessment of the cause of death and the circumstances.

Case History: The body of a 57 years old man with a history of psychiatric illness was found in his room. At autopsy a round wooden rod which was inserted through the anus was found in the peritoneal and pleural cavities. In addition, signs of manual pressure were detected on the neck and trunk, and on the head and extremities signs of blunt trauma were observed.

Discussion: In patients affected by mental disorders it is difficult to distinguish between self-inflicted anal injuries and injuries sustained during an attack. Detection of damage to other areas of the body (such as the neck) assist in determining the nature of the assault.

Summary: This case demonstrates the need for a full autopsy in every case of death under unclear circumstances, especially when a limited examination of the body can't determine the type of death (natural, accident, suicide or homicide).

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