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Abdominal Injuries

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Comparative Studies 1-6

  • Of the six comparative studies, four addressed blunt abdominal injuries 1,4-6
    • All studies indentified abused children with abdominal injury as significantly younger than accidentally injured children, with the mean age across the three studies for abused children all being less than three years 1,4-6
    • The commonest cause of accidental injury was motor vehicle collision.1,4-6
    • Where given, the mean age of the accidentally injured group was greater than seven years 1,4,6
    • No child less than four years of age sustained an accidental duodenal injury from a fall 1,2
    • No child less than two sustained a duodenal injury from any accidental mechanism 5
    • Co-existent injuries were common amongst the abused cohort (including fractures, head injury, burns, bites and oral injury 1,4,6
  • Two exclusively addressed duodenal injuries 2,5
    • Duodenal injuries are rare in childhood, accounting for 0.3% of abdominal trauma 2, accounting for 1.5/1000 trauma admissions in children less than five years old 5
    • The commonest accidental mechanism of injury was motor vehicle collision 2,5
    • Abused children with duodenal injury were significantly younger (mean age 2.25 + / – 0.7 years) than accidentally injured children (mean age 7.6 + / – 4.4 years) 2, no child less than two years of age sustained an accidental duodenal injury 5
    • Only 1 / 8 abused children had bruising to the upper abdomen 2
    • Abused children were more likely to experience transections than non-abused (35% vs 17%) 5, although perforation was equally likely in another study 2
  •  One exclusively addressed pancreatic injury 3
    • Abuse was the third commenest cause of pancreatic injury, with motor vehicle collisions being the predominant cause
    • Mortality for pancreatic injury was low overall, however 4 / 10 abused children died
    • Co-existent injury was present in the fatal cases

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References

  1. Barnes PM, Norton CM, Dunstan FD, Kemp AM, Yates DW, Sibert JR. Abdominal injury due to child abuse. Lancet. 2005;366(9481):234-235 [Pubmed]
  2. Gaines BA, Shultz BS, Morrison K, Ford HR. Duodenal injuries in children: Beware of child abuse. Journal of Pediatric Surgery. 2004;39(4):600-602 [Pubmed]
  3. Jacombs ASW, Wines M, Holland AJA, Ross FI, Shun A, Cass DT. Pancreatic trauma In children. Journal of Pediatric Surgery. 2004;39(1):96-99 [Pubmed]
  4. Ledbetter DJ, Hatch Jr EI, Feldman KW, Fligner CL, Tapper D. Diagnostic and surgical implications of child abuse. Archives of Surgery. 1988;123(9):1101-1105 [Pubmed]
  5. Sowrey L, Lawson KA, Garcia-Filion P, Notrica D, Tuggle D, Eubanks III JW, Maxson RT, Recicar J, Megison SM, Garcia NM. Duodenal injuries in the very young: child abuse? The Journal of Trauma and Acute Care Surgery. 2013;74(1):136-141. [Pubmed]

  6. Wood J, Rubin, DM, Nance, ML, Christian, CW. Distinguishing inflicted versus accidental abdominal injuries in young children. The Journal of Trauma, Injury, Infection and Critical Care. 2005;59(5):1203-1208 [Pubmed]

Solid Organ Injuries

  • 24 studies predominantly described details of hepatic injury 1-24
    • Children were aged three weeks to eight years (where age is given) 1-24
    • The hepatic injuries included lacerations, contusions, subcapsular haematomas and complete transection of the liver 1-24
    • Co-existent injury included bruising, rib fractures, head injuries, additional abdominal trauma, intra-thoracic trauma and bites 1-24
    • Bruising to the abdomen was recorded in 26 / 37  cases 1,4,5,7-15,18-22

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References

  1. Aoki Y, Nata M., Hashiyada M, Sagisaka K. Laceration of the liver with delayed massive intra-abdominal hemorrhage: a case report of child abuse. Japanese Journal of Legal Medicine. 1997;51(1):44-47 [Pubmed]
  2. Anchala K, Wright MS. Finding the hidden injury: Pediatric trauma puzzlers. Clinical Pediatric Emergency Medicine. 2001;2(1):71-75 [Citation provided by Science Direct]
  3. Barnes PM, Norton CM, Dunstan FD, Kemp AM, Yates DW, Sibert JR. Abdominal injury due to child abuse. Lancet. 2005;366(9481):234-235 [Pubmed]
  4. Beauchamp JM, Belanger MA, Neitzschman HR. The diagnosis of subcapsular hematoma of the liver by scintigraphy. Southern Medical Journal. 1976;69(12):1579-1581 [Pubmed]
  5. Cameron CM, Lazoritz S, Calhoun AD. Blunt abdominal injury: Simultaneously occurring liver and pancreatic injury in child abuse. Pediatric Emergency Care. 1997;13(5):334-336 [Pubmed]
  6. Caniano DA, Beaver BL, Boles ET. Child abuse. An update on surgical management in 256 cases. Annals of Surgery. 1986;203(2):219-224 [Pubmed]
  7. Coant PN, Kornberg AE, Brody AS, Edwards-Holmes K. Markers for occult liver injury in cases of physical abuse in children. Pediatrics. 1992;89(2):274-278 [Pubmed]
  8. Conradi S, Brissie R. Battered child syndrome in a four year old with previous diagnosis of Reye's syndrome. Forensic Science International. 1986;30(2-3):195-203 [Pubmed]
  9. Fain DB, McCormick GM. An unusual case of child abuse homicide/suicide. Journal of Forensic Sciences. 1988;33(2):554-557 [Pubmed]
  10. Grosfeld JL, Ballantine TVN. Surgical aspects of child abuse (trauma-X). Pediatric Annals. 1976;5(10):106-120 [Pubmed citation only]
  11. Gunther WM, Symes SA, Berryman HE. Characteristics of child abuse by anteroposterior manual compression versus cardiopulmonary resuscitation: case reports. American Journal of Forensic Medicine & Pathology. 2000;21(1):5-10 [Pubmed]
  12. Hamilton A, Humphreys WG. Duodenal rupture complicating childhood non-accidental injury. Ulster Medical Journal. 1985;54(2):221-223 [Pubmed]
  13. Hicks RA, Gaughan DC. Understanding fatal child abuse. Child Abuse and Neglect. 1995;19(7):855-863 [Pubmed]
  14. Hilmes MA, Hernanz-Schulman M, Greeley CS, Piercey LM., Yu C, Kan JH. CT identification of abdominal injuries in abused pre-school-age children. Pediatric Radiology. 2011;41(5):643-651 [Pubmed]
  15. Kleinman PK, Raptopoulos VD, Brill PW. Occult nonskeletal trauma in the battered-child syndrome. Radiology. 1981;141(2):393-396 [Pubmed citation only]
  16. Ledbetter DJ, Hatch Jr EI, Feldman KW, Fligner CL, Tapper D. Diagnostic and surgical implications of child abuse. Archives of Surgery. 1988;123(9):1101-1105 [Pubmed]
  17. Lindberg D, Makoroff K, Harper N, Laskey A, Bechtel K, Deye K, Shapiro R, for the ULTRA Investigators. Utility of hepatic transaminases to recognize abuse in children. Pediatrics. 2009;124(2):509-516 [Pubmed]
  18. McCort J, Vaudagna J. Visceral injuries in battered children. Radiology. 1964; 82:424-428 [Pubmed citation only]
  19. Ng CS, Hall CM. Costochondral junction fractures and intra-abdominal trauma in non-accidental injury (child abuse). Pediatric Radiology. 1998;28(9):671-676 [Pubmed]
  20. Ng CS, Hall CM, Shaw DG. The range of visceral manifestations of non-accidental injury. Archives of Disease in Childhood. 1997;77(2):167-174 [Pubmed citation only]
  21. Salmon MA. The spectrum of abuse in the battered-child syndrome. Injury. 1971;2(3):211-217 [Pubmed citation only]
  22. Simpson K. Battered babies: Conviction for murder. British Medical Journal. 1965;1(5431):393
  23. Sujka SK, Jewett, TC, Jr, Karp, MP. Acute scrotal swelling as the first evidence of intraabdominal trauma in a battered child. Journal of Pediatric Surgery. 1988;23(4):380 [Pubmed]
  24. Wood J, Rubin, DM, Nance, ML, Christian, CW. Distinguishing inflicted versus accidental abdominal injuries in young children. The Journal of Trauma, Injury, Infection and Critical Care. 2005;59(5):1203-1208 [Pubmed]

  • A report of a six month old infant noted needles inserted into the left lobe of the liver 1

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References

  1. Stone RK, Harawitz, A, San Filippo, JA, Gromisch, DS. Needle perforation of the liver in an abused infant. Clinical Pediatrics. 1976;15(10):958-959 [Pubmed citation only]

  • Splenic injury was less frequently recorded 1-6
    • Amongst the comparative studies, one study did not report any abusive splenic injuries 4 whilst two studies noted them to be equally prevalent amongst abusively and accidentally injured children 1,6
    • Where described, the majority of children presented with haemodynamic shock, although presence or absence of abdominal bruising was rarely noted (one case of multiple abdominal organ injury recorded abdominal brusing 6)
    • Details of co-existent injuries were not uniformly available. Where noted, they included other abdominal injuries 1-6

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References

  1. Barnes PM, Norton CM, Dunstan FD, Kemp AM, Yates DW, Sibert JR. Abdominal injury due to child abuse. Lancet. 2005;366(9481):234-235 [Pubmed]
  2. Caniano DA, Beaver BL, Boles ET. Child abuse. An update on surgical management in 256 cases. Annals of Surgery. 1986;203(2):219-224 [Pubmed]
  3. Hilmes MA, Hernanz-Schulman M, Greeley CS, Piercey LM., Yu C, Kan JH. CT identification of abdominal injuries in abused pre-school-age children. Pediatric Radiology. 2011;41(5):643-651 [Pubmed]
  4. Ledbetter DJ, Hatch Jr EI, Feldman KW, Fligner CL, Tapper D. Diagnostic and surgical implications of child abuse. Archives of Surgery. 1988;123(9):1101-1105 [Pubmed]
  5. Ng CS, Hall CM, Shaw DG. The range of visceral manifestations of non-accidental injury. Archives of Disease in Childhood. 1997;77(2):167-174 [Pubmed citation only]
  6. Wood J, Rubin, DM, Nance, ML, Christian, CW. Distinguishing inflicted versus accidental abdominal injuries in young children. The Journal of Trauma, Injury, Infection and Critical Care. 2005;59(5):1203-1208 [Pubmed]

  • Pancreatic injuries were predominantly addressed in 10 studies 1-10
    • One comparative study noted that motor vehicle collisions were the commenest cause of accidental injury. A third of patients died and abuse was the second commenest aetiology amongst fatal cases 4
    • The pancreatic trauma included transection of the head of the pancreas, acute necrotising pancreatitis, chronic pancreatitis and pseudocyst formation 1-10
    • Complications of pancreatic injury included pseudocyst formation 2,5,6,8,9
    • An important late manifestation included osteolytic lesions causing pain and limitation of movement. These predominantly affect long bones, phalanges, tarsals and metatarsals, and may be accompanied by fever 6,10
    • Many children with pancreatic injury had co-existent additional abdominal injuries and other injuries including burns, fractures, head injury and bruising 1-10

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References

  1. Chen MH, Lee CH, Wu CL, Su MC, Wu WH, Yeh WR. Sonographic presentation of chronic pancreatitis complicated with acute duodenal obstruction in a battered child. Journal of Clinical Ultrasound. 1994;22(5):334-337 [Pubmed]
  2. Grosfeld JL, Ballantine TVN. Surgical aspects of child abuse (trauma-X). Pediatric Annals. 1976;5(10):106-120 [Pubmed citation only]
  3. Hilmes MA, Hernanz-Schulman M, Greeley CS, Piercey LM., Yu C, Kan JH. CT identification of abdominal injuries in abused pre-school-age children. Pediatric Radiology. 2011;41(5):643-651 [Pubmed]
  4. Jacombs ASW, Wines M, Holland AJA, Ross FI, Shun A, Cass DT. Pancreatic trauma In children. Journal of Pediatric Surgery. 2004;39(1):96-99 [Pubmed]
  5. Kleinman PK, Raptopoulos VD, Brill PW. Occult nonskeletal trauma in the battered-child syndrome. Radiology. 1981;141(2):393-396 [Pubmed citation only]
  6. Neuer FS, Roberts FF, McCarthy V. Osteolytic lesions following traumatic pancreatitis. American Journal of Diseases of Children. 1977;131(7):738-740 [Pubmed]
  7. Ng CS, Hall CM. Costochondral junction fractures and intra-abdominal trauma in non-accidental injury (child abuse). Pediatric Radiology. 1998;28(9):671-676 [Pubmed]
  8. Ng CS, Hall CM, Shaw DG. The range of visceral manifestations of non-accidental injury. Archives of Disease in Childhood. 1997;77(2):167-174 [Pubmed citation only]
  9. Pena SD, Medovy H. Child abuse and traumatic pseudocyst of the pancreas. Journal of Pediatrics.1973;83(6):1026-1028 [Pubmed citation only]
  10. Slovis TL, Berdon, WE, Haller, JO, Baker, DH, Rosen, L. Pancreatitis and the battered child syndrome. Report of 2 cases with skeletal involvement. American Journal of Roentgenology, Radium Therapy & Nuclear Medicine. 1975;125(2):456-461 [Pubmed]

  • Renal trauma was predominantly addressed in three studies 1-3
    • It was the primary injury described in a four month old infant presenting with collapse due to sepsis. It was noted that the left kidney was infarcted in addition to splenic infarction and co-existent fractures 3
    • Seven further cases of renal trauma were described in conjunction with other abdominal injuries 1
    • One case of renal vascular injury to an ectopic kidney is also reported 2

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References

  1. Hilmes MA, Hernanz-Schulman M, Greeley CS, Piercey LM., Yu C, Kan JH. CT identification of abdominal injuries in abused pre-school-age children. Pediatric Radiology. 2011;41(5):643-651 [Pubmed]
  2. Rosenberg HK. Traumatic avulsion of the vascular supply of a crossed unfused ectopic kidney: complementary roles of ultrasonography and intravenous pyelography. Journal of Ultrasound in Medicine. 1984;3(2):89-91 [Pubmed]
  3. Wilson TM, Anderson, BJ, Duncan, D. Nonaccidental injury presenting as pneumococcal sepsis in an infant. Pediatric Emergency Care. 1996;12(4):283-284 [Pubmed citation only]

  • Three studies recorded additional solid organ injuries, including adrenal haematoma 2,3 and adrenal laceration, including almost complete transection in one case 1
    • Brusing to the abdomen / trunk was present in all cases, and multiple co-existent injuries were also present, including further abdominal injury, head injury, fractures and oral injury 1-3

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References

  1. deRoux SJ, Prendergast NC. Adrenal lacerations in child abuse: a marker of severe trauma. Pediatric Surgery International. 2000;16(1-2):121-123 [Pubmed]
  2. Hicks RA, Gaughan DC. Understanding fatal child abuse. Child Abuse and Neglect. 1995;19(7):855-863 [Pubmed]
  3. Hilmes MA, Hernanz-Schulman M, Greeley CS, Piercey LM., Yu C, Kan JH. CT identification of abdominal injuries in abused pre-school-age children. Pediatric Radiology. 2011;41(5):643-651 [Pubmed]

 Hollow Organ Injuries

  • Overall, hollow organ injuries were recorded as frequently as solid organ injuries 1-29, however duodenal injuries occurred more commonly than expected
  • Comparative studies highlighted the rarity of duodenal injury in accidental trauma and its relative frequency in abused children 2,11,18,27
    • Duodenal injury did not occur as a consequence of falls in any child less than four years of age 2,11,27
  • Features of duodenal injury recorded in both comparative and non-comparative
    studies include intra-mural heamatoma (with or without bowel obstruction), complete transection, subserosal haematoma, perforation or inflammation 1-29
    • The commonest duodenal injury involved a transection or perforation between the third and fourth part of the duodenum 2,7,8,15.19-21.26.29
    • Where age was detailed, the children ranged from one week of age to five years of age 1-21,23-29 and a single case of a severely disabled thirteen year old child with an intra-mural haematoma of the second part of the duodenum 22
    • Many children presented with an acute abdomen, although some cases did not come to attention for some days after the onset of symptoms 3,5,10,12,13,24,25
    • Co-existent injuries were frequently present, predominantly other abdominal injuries, but also fractures, head injury, and burns 1-29

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References

  1. Anchala K, Wright MS. Finding the hidden injury: Pediatric trauma puzzlers. Clinical Pediatric Emergency Medicine. 2001;2(1):71-75 [Citation provided by Science Direct]
  2. Barnes PM, Norton CM, Dunstan FD, Kemp AM, Yates DW, Sibert JR. Abdominal injury due to child abuse. Lancet. 2005;366(9481):234-235 [Pubmed]
  3. Beckmann KR, Nozicka CA. Small bowel perforation: an unusual presentation for child abuse. Journal of the American Osteopathic Association. 2000;100(8):496-497 [Pubmed]
  4. Bratu M, Dower JC, Siegel B, Hosney SH. Jejunal hematoma, child abuse, and Felson's sign. Connecticut Medicine. 1970;34(4):261-264 [Pubmed]
  5. Cameron CM, Lazoritz S, Calhoun AD. Blunt abdominal injury: Simultaneously occurring liver and pancreatic injury in child abuse. Pediatric Emergency Care. 1997;13(5):334-336 [Pubmed]
  6. Caniano DA, Beaver BL, Boles ET. Child abuse. An update on surgical management in 256 cases. Annals of Surgery. 1986;203(2):219-224 [Pubmed]
  7. Cordner SM, Burke MP, Dodd MJ, Lynch MJ, Ranson DL, Robertson SD. Issues in child homicides: 11 cases. Legal Medicine. 2001;3(2):95-103 [Pubmed]
  8. deRoux SJ, Prendergast NC. Lacerations of the hepatoduodenal ligament, pancreas and duodenum in a child due to blunt impact. Journal of Forensic Sciences. 1998;43(1):222-224 [Pubmed]
  9. Dworkind M, McGowan G, Hyams J. Abdominal Trauma - Child Abuse. Pediatrics. 1990;85(5):892 [Pubmed citation only]
  10. Eisenstein EM, Delta BG, Clifford JH. Jejunal hematoma: an unusual manifestation of the battered-child syndrome. Clinical Pediatrics. 1965;4(8):436-440 [Pubmed citation only]
  11. Gaines BA, Shultz BS, Morrison K, Ford HR. Duodenal injuries in children: Beware of child abuse. Journal of Pediatric Surgery. 2004;39(4):600-602 [Pubmed]
  12. Glick RD, La Quaglia MP. Fungal sepsis in a patient with duodenal hematoma. Journal of Pediatric Surgery. 2000;35(4):627-629 [Pubmed]
  13. Gornall P, Ahmed S, Jolleys A, Cohen SJ. Intra-abdominal injuries in the battered baby syndrome. Archives of Disease in Childhood. 1972;47(252):211-214 [Pubmed citation only]
  14. Gurland B, Dolgin SE, Shlasko E, Kim U. Pneumatosis intestinalis and portal vein gas after blunt abdominal trauma. Journal of Pediatric Surgery. 1998;33(8):1309-1311 [Pubmed]
  15. Hamilton A, Humphreys WG. Duodenal rupture complicating childhood non-accidental injury. Ulster Medical Journal. 1985;54(2):221-223 [Pubmed]
  16. Hilmes MA, Hernanz-Schulman M, Greeley CS, Piercey LM., Yu C, Kan JH. CT identification of abdominal injuries in abused pre-school-age children. Pediatric Radiology. 2011;41(5):643-651 [Pubmed]
  17. Kelley JE. Duodenal hematoma: Case report. Military Medicine. 1982;147(2):106-108 [Pubmed citation only]
  18. Ledbetter DJ, Hatch Jr EI, Feldman KW, Fligner CL, Tapper D. Diagnostic and surgical implications of child abuse. Archives of Surgery. 1988;123(9):1101-1105 [Pubmed]
  19. McCort J, Vaudagna J. Visceral injuries in battered children. Radiology. 1964; 82:424-428 [Pubmed citation only]
  20. Ng CS, Hall CM, Shaw DG. The range of visceral manifestations of non-accidental injury. Archives of Disease in Childhood. 1997;77(2):167-174 [Pubmed citation only]
  21. Nijs S, Vanclooster P, de Gheldere C, Garmijn K. Duodenal transection in a battered child: a case report. Acta Chirurgica Belgica. 1997;97(4):192-193 [Pubmed]
  22. Orel SG, Nussbaum AR, Sheth S, Yale-Loehr A, Sanders RC. Duodenal hematoma in child abuse: sonographic detection. AJR American Journal of Roentgenology. 1988;151(1):147-149 [Pubmed citation only]
  23. Porzionato A, Macchi V, Aprile A, De Caro R. Cervical soft tissue lesions in the shaken infant syndrome: a case report. Medicine Science and the Law. 2008;48(4):346-349 [Pubmed]
  24. Stewart DR, Byrd, CL, Schuster, SR. Intramural hematomas of the alimentary tract in children. Surgery. 1970;68(3):550-557 [Pubmed citation only]
  25. Terreros A, Zimmerman, S. Duodenal hematoma from a fall down the stairs. Journal of Trauma Nursing. 2009;16(3):166-168 [Pubmed]
  26. Tracy T, Jr, O'Connor, TP, Weber, TR. Battered children with duodenal avulsion and transection. American Surgeon. 1993;59(6):342-345 [Pubmed]
  27. Wood J, Rubin, DM, Nance, ML, Christian, CW. Distinguishing inflicted versus accidental abdominal injuries in young children. The Journal of Trauma, Injury, Infection and Critical Care. 2005;59(5):1203-1208 [Pubmed]
  28. Wu JW, Chen, MY, Auringer, ST. Portal venous gas: an unusual finding in child abuse. The Journal of Emergency Medicine. 2000;18(1):105-107 [Pubmed citation only]
  29. Yavuz MS, Buyukyavuz, I, Savas, C, Ozguner, IF, Kupeli, A, Asirdizer, M. A battered child case with duodenal perforation. Journal of Forensic and Legal Medicine. 2008;15(4):259-262 [Pubmed]

  • An eight week old infant is described with multiple needle insertions in the abdomen, including penetration of the rectum 1. In addition, an 11 year old child is described with multiple needle insertions in the abdomen and one in the lower chest, including perforation of the caecum and liver 2.

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References

  1. Ng CS, Hall CM, Shaw DG. The range of visceral manifestations of non-accidental injury. Archives of Disease in Childhood. 1997;77(2):167-174 [Pubmed citation only]
  2. Swadia ND, Thakore, AB, Patel, BR, Bhavani, SS. Unusual form of child abuse presenting as an acute abdomen. British Journal of Surgery. 1981;68(9):668 [Pubmed citation only]

  • A single case of gastric rupture was recorded in a two year old child, occuring due to a forceful blow to the abdomen, straight after a feed 1

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References

  1. Case ME, Nanduri R. Laceration of the stomach by blunt trauma in a child: a case of child abuse. Journal of Forensic Sciences. 1983;28(2):496-501 [Pubmed]

  • Bladder rupture was the primary injury in six studies, in children aged four months to six years 1-6
    • Rupture to the dome of the bladder occurred in all instances and the children presented variably with collapsed abdominal symptoms, haematuria, reduced urinary output and vomiting 1-6
    • These highlight the potential mechanism as being a direct blow to a full bladder leading to an acute rise in intravesical pressure 6
    • Four out of the six children had no additional co-existent injuries other than bruising 1,2,5,6

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References

  1. Halsted CC, Shapiro SR. Child abuse: acute renal failure from ruptured bladder. American Journal of Diseases of Children. 1979;133(8):861-862 [Pubmed citation only]
  2. Lautz T, Leonhardt D, Rowell E, Reynolds M. Intraperitoneal bladder rupture as an isolated manifestation of nonaccidental trauma in a child. Pediatric Emergency Care. 2009;25(4):260-262 [Pubmed]
  3. Ng CS, Hall CM, Shaw DG. The range of visceral manifestations of non-accidental injury. Archives of Disease in Childhood. 1997;77(2):167-174 [Pubmed citation only]
  4. Sawyer RW, Hartenberg MA, Benator RM. Intraperitoneal bladder rupture in a battered child. International Journal of Pediatric Nephrology. 1987;8(4):227-230 [Pubmed]
  5. Sirotnak AP. Intraperitoneal bladder rupture: an uncommon manifestation of child abuse. Clinical Pediatrics. 1994;33(11):695-696 [Pubmed citation only]
  6. Yang JW, Kuppermann, N, Rosas, A. Child abuse presenting as pseudorenal failure with a history of a bicycle fall. Pediatric Emergency Care. 2002;18(2):91-92 [Pubmed citation only]

  • Colonic injuries are described in four studies, representing 100 abused children of whom four sustained large bowel injuries, all of which were in conjunction with other injuries1-4
    • The injuries recorded included colonic contusions,4 rectal perforation,3 serosal tears of the colon,2 pneumatosis intestinalis 2 and meso-colonic tear 1

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References

  1. Gunther WM, Symes SA, Berryman HE. Characteristics of child abuse by anteroposterior manual compression versus cardiopulmonary resuscitation: case reports. American Journal of Forensic Medicine & Pathology. 2000;21(1):5-10 [Pubmed]
  2. Gurland B, Dolgin SE, Shlasko E, Kim U. Pneumatosis intestinalis and portal vein gas after blunt abdominal trauma. Journal of Pediatric Surgery. 1998;33(8):1309-1311 [Pubmed]
  3. Hilmes MA, Hernanz-Schulman M, Greeley CS, Piercey LM., Yu C, Kan JH. CT identification of abdominal injuries in abused pre-school-age children. Pediatric Radiology. 2011;41(5):643-651 [Pubmed]
  4. Wood J, Rubin, DM, Nance, ML, Christian, CW. Distinguishing inflicted versus accidental abdominal injuries in young children. The Journal of Trauma, Injury, Infection and Critical Care. 2005;59(5):1203-1208 [Pubmed]

Further Abdominal Injuries

  • Trauma to the abdominal lymphatics presenting as chylous ascites was recorded in a group of children aged 10 weeks – two and a half years 1-6
    • Increasing abdominal distension was the commonest presentation although one child presented with a chyle filled hernia 5
    • Co-existent injuries included fractures, burns, bruising, faltering growth, additional abdominal injuries and head injury 1-6

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References

  1. Benhaim P, Strear C, Knudson M, Neal C, Coulter K, Villarreal S. Posttraumatic chylous ascites in a child: recognition and management of an unusual condition. The Journal of Trauma, Injury, Infection and Critical Care. 1995;39(6):1175-1177 [Pubmed]
  2. Beshay VE, Beshay JE, Rosenberg AJ. Chylous ascites: A case of child abuse and an overview of a rare condition. Journal of Pediatric Gastroenterology and Nutrition. 2001;32(4):487-489 [Pubmed]
  3. Boysen, BE. Chylous ascites: Manifestation of the battered child syndrome. American Journal of Diseases of Children. 1975;129(11):1338-1339 [Pubmed]
  4. Dillard RP, Stewart AG. Total parenteral nutrition in the management of traumatic chylous ascites in infancy. Clinical Pediatrics. 1985;24(5):290-292 [Pubmed]
  5. Olazagasti JC, Fitzgerald JF, White SJ, Chong SKF. Chylous ascites: A sign of unsuspected child abuse. Pediatrics. 1994;94(5):737-739 [Pubmed citation only]
  6. Vollman RW, Keenan, WJ, Eraklis, AJ. Post-traumatic chylous ascites in infancy. New England Journal of Medicine. 1966;275(16):875-877 [Pubmed citation only]

 

 

 

 

 

 

 

 

 

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