Abstract: The ends of metal railings forming the top part of fences and gates may terminate in various types of decorative finishes, often in sharp, tapered tips. These tapered ends serve as a security measure to deter any trespassing. Accidental deaths linked to sharp tips of fences or gates can be a result of suspension or impalement injuries and are of great rarity in medico-legal literature. Herein, we provide a case of a rare double impalement injury sustained on an iron-spiked fence gate. A 51-year-old man was found alive, impaled on iron-spiked fence gate. Despite the rapid response of neighbor and paramedics, the man died shortly after hospital admission. The autopsy disclosed two channel-like penetration wounds projecting from right scrotum and perineum, consistent with the fence gate spikes, which communicated with the abdominal cavity. It seemed that the decedent, under the influence of ethanol, attempted to climb over the iron-spiked fence gate on which he accidentally impaled himself. The established cause of death was hemorrhagic shock due to numerous tears of pelvic vasculature caused by impalement injury on an iron-spiked fence gate. Despite the high-energy trauma commonly seen in impalement injuries, low-energy trauma, such as in our case, can result in death. Such injuries should not be disregarded or misrepresented for their topographical or morphological attributes. In addition, retention of foreign objects embedded in the wounds is a widely approved medical approach that minimizes the bleeding and could prevent death. In case of impalement injuries, the same should be followed. Keywords: impalement injury, iron-spiked fence gate, exsanguination, pelvic blood vessels, scrotal penetrating injury, perineal penetrating injury.
