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Implications for practice

  • Many abdominal injuries, in particular hepatic injury, may be clinically occult and thus active consideration of blunt abdominal injury in children with suspected abuse is necessary
  • Abdominal injuries such as transection or laceration of the third / fourth part of the duodenum in children aged less than five years, particularly those less than two years old, who have not experienced a motor vehicle collision should prompt specific child protection investigations
  • In the child sustaining head injury or who is unconscious as a consequence of their abusive injuries, abdominal injuries must be considered during their investigation
  • Many children sustaining abusive abdominal injury have evidence that there has been repeated blunt abdominal injury, although they have not come to attention with previous injuries. Thus, non-specific symptoms in young children with suspected abuse should prompt abdominal investigations
  • Absence of bruising does not preclude the presence of significant abdominal injury as up to 80% of cases may have no bruising present 1-4

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References

  1. Bowkett B, Kolbe, A. Traumatic duodenal perforations in children: child abuse a frequent cause. Australian & New Zealand Journal of Surgery. 1998;68(5):380-382 [Pubmed citation only]
  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. Herr S, Fallat, ME. Abusive abdominal and thoracic trauma. Clinical Pediatric Emergency Medicine. 2006;7(3):149-152 [Abstract provided by Science Direct]
  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]



 

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