You are here » CORE INFO » Reviews » Visceral Injuries » What are the features of visceral injuries occurring as a consequence of physical abuse? » Other useful references

Other useful references

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.


Visceral consequences of injury

  • Rhabdomyolysis has been described as a consequence of severe physical abuse with multiple extensive bruises, and has resulted in renal failure 1,2
  • Commotio cordis has been described where the assault on the child involves a direct blow to the chest resulting in ventricular dysrhythmia and subsequent death. Significantly, no pathological abnormality was found in the heart on autopsy and in only one case were co-existent rib fractures present (in this child the perpetrator also admitted to severe squeezing of the chest) 3-5

Vulnerability of infants to abdominal injury

  • Young children are suscebtible to injury due to a less muscular, thin abdominal wall, the diaphragm being more horizontal and the liver and spleen more anterior, thus less protected by ribs. As the ribs themselves are elastic and more compressible, direct trauma to the chest may crush solid organs below 6


  • While the following studies did not meet our inclusion criteria for rank of abuse, they provide a population estimate of:
    • The prevalence of abusive abdominal trauma in children in the USA 7,8,9
    • The proportion of children with fatal abuse with abdominal injury in the UK 10

Trauma service involvement

  • Given the prevalence of poly-trauma amongst abused infants and children, prompt trauma service evaluation would be of value 11


Click here to open


  1. Lazarus SG, Wittkamp M, Messner S. Physical abuse leading to renal failure: a unique case of rhabdomyolysis. Clinical Pediatrics. 2014;53(7):701-703. [Pubmed]

  2. Peebles J, Losek JD. Child physical abuse and rhabdomyolysis: Case report and literature review. Pediatric Emergency Care. 2007;23(7):474-477 [Pubmed]
  3. Baker AM, Craig BR, Lonergan GJ. Homicidal commotio cordis: the final blow in a battered infant. Child Abuse and Neglect. 2003;27(1):125-130 [Pubmed]
  4. Denton, JS, Kalelkar MB, Denton JS, Kalelkar MB. Homicidal commotio cordis in two children. Journal of Forensic Sciences. 2000;45(3):734-735 [Pubmed]
  5. Boglioli LR, Taff ML, Harleman G. Child homicide caused by commotio cordis. Pediatric Cardiology. 1998;19(5):436-438 [Pubmed]
  6. Gaines BA, Ford HR. Abdominal and pelvic trauma in children. Critical Care Medicine. 2002;30(11 Suppl):S416-23 [Pubmed]
  7. Lane WG, Dubowitz H, Langenberg P, Dischinger, P. Epidemiology of abusive abdominal trauma hospitalizations in United States children Child Abuse & Neglect. 2012;36(2):142-148. [Pubmed]

  8. Figler BD, Webman R, Ramey C, Kaye J, Patrick E, Kirsch A, Smith E, Master VA. Pediatric adrenal trauma in the 21st century: children's hospital of Atlanta experience. Journal of Urology. 2011;186(1):248-251. [Pubmed]

  9. Cuenca AG, Islam S. Pediatric pancreatic trauma: trending toward nonoperative management? American Surgeon. 2012;78(11):1204-1210. [Pubmed]

  10. Sidebotham P, Bailey S, Belderson P, Brandon M. Fatal child maltreatment in England, 2005- 2009 Child Abuse & Neglect. 2011;35(4):299-306. [Pubmed]

  11. Larimer EL, Fallon SC, Westfall J, Frost M, Wesson DE, Naik-Mathuria BJ. The importance of surgeon involvement in the evaluation of non-accidental trauma patients. Journal of Pediatric Surgery. 2013;48(6):1357-62 [Pubmed]






^ back to top