Death Secondary to a Donkey’s Bites Ernesto d’Aloja, MD, PhD,* Leonardo Grimaldi, MD, PhD,Þ Fidelia Cascini, MD, PhD,Þ Domenico De Mercurio, MD,Þ and Fabio De-Giorgio, MD, PhDÞ Abstract: We present a unique case of death due to the assault and bites of a donkey on a 65-year-old man. The farmer, found dead in his farmyard, had a very deep wound in the anterior region of the neck, with a sharp transection of the trachea and severe bleeding by several minor vessels wall disruptions. The cause of death was established to be mas- sive bleeding combined with asphyxia due to aspiration of the blood. Moreover, multiple contusions with associated skin abrasions and per- forations were present. The general impression of the injuries was con- sistent with an animal’s bite marks. Herbivorous or omnivorous bite attacks on humans are rare; instead, these animals attack by kicking, trampling, and kneeling, resulting in secondary blunt injuries. The donkey is usually a docile animal, but its behavior can be aggressive during the mating season, and the possibility of biting should not be underestimated, as illustrated by the 2 cases published previously as well as by the case presented here. Key Words: forensic science, donkey bite, animal attack, bite mark, fatal donkey mauling, forensic autopsy (Am J Forensic Med Pathol 2011;32: 183Y185) H uman injuries due to animal bites can be considered rela- tively common. The animals most frequently associated with these assaults are dogs and big cats. 1Y18 Fatalities related to an- imal bites, however, are relatively rare. According to reports from the United States, approximately 1 million to 4.7 million persons sustain dog bites annually, 1Y3 whereas 157 and 109 of these events were fatal in 1979Y1988 and in 1989Y1994, respectively. 4,5 Carnivorous animals are involved in the great majority of attacks on humans, whereas herbivores or omnivores seldom show this aggressive behavioral pattern. Injuries associated with horses and donkeys are usually produced by animal kicks or by falls during riding. Stavrev 19 reported a case of open multiple forearm fractures caused by a donkey bite, and Gomes et al 20 reported a case of a minor penile laceration of a 7-year-old boy due to a donkey bite, but fatal bite injuries by a donkey have not been previously published. CASE REPORT A 65-year-old man was found dead in his farmyard. His body was lying supine under a tree near the fence separating his property from an adjacent road. The deceased was normally dressed, but the upper right portion of his shirt was torn. Present inside the yard was an adult male donkey, apparently docile and uninterested in the corpse. On its upper lip, a small bloodstain was visible and subsequently collected by the investigators. Settled in the bordering court was a donkey herd, containing both male and female animals. The victim had a very deep wound in the anterior region of the neck, extending from the jugular notch to the upper part of the laryngeal prominence, and to the inner edge of the sternoclei- domastoid muscles on both sides (Fig. 1). Through the wound, a sharp transection of the anterolateral wall of the trachea and a composite fracture of the thyroid cartilage were visible. At au- topsy, the trachea was found to be almost completely severed, with only a small portion of the posterior membranous wall remain- ing intact. Severe bleeding by several minor vessels wall disrup- tions was detected in this area. An intratracheal hemorrhage leading to blood aspiration was observed. Macroscopically, the lungs showed evidence of massive alveolar blood invasion of the inferior lobes. No fractures of the cervical column were detected by either direct inspection or by x-rays. The cause of death was established to be massive bleeding combined with asphyxia due to aspiration of the blood. A deep contusion was visible in the right shoulder area, with an extensive reddish hematoma, and 2 distinct wounds in- volving metacarpal bone fractures of the right hand were present. These injuries were considered to be defense wounds. Moreover, multiple contusions with associated skin abra- sions and perforations, especially in the face, right arm, and tho- rax, were present. These contusions showed a common pattern, although not always easily recognizable because of the numerous different wounds. Most of the wounds were relatively superficial and limited to muscular tissue, not penetrating into the body cavities. Not all wounds were likely to have been produced at the same time. For example, some abrasions on the chest had a brownish color and a papyrus-like consistency; they were con- sidered to be inflicted postmortem. The general impression of the injuries was consistent with an animal’s bite marks. Therefore, a dental impression of the FIGURE 1. The bite wound on the neck (arrow). CASE REPORT Am J Forensic Med Pathol & Volume 32, Number 2, June 2011 www.amjforensicmedicine.com 183 Manuscript received October 27, 2008; accepted May 27, 2009. From the *Institute of Legal Medicine, University of Cagliari, School of Medicine, Cagliari; and †Institute of Legal Medicine, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy. Reprints: Fabio De-Giorgio, MD, PhD, Institute of Legal Medicine, Catholic University of the Sacred Heart, School of Medicine, Largo Francesco Vito, 1, 00168 Rome, Italy. E-mail: fdegiorgio@tiscalinet.it; fabio.degiorgio@rm.unicatt.it. Copyright * 2011 by Lippincott Williams & Wilkins ISSN: 0195-7910/11/3202Y0183 DOI: 10.1097/PAF.0b013e318219cfce Copyright © 2011 by the American Psychosomatic Society. Unauthorized reproduction of this article is prohibited.