Blunt Abdominal Injury in Suspected Child Abuse Patients: A Three-Case Report

Abstract

Objective: To identify characteristics associated with suspected child abuse in the setting of blunt abdominal trauma.

Methods: Retrospective review.

Results: Three cases of blunt abdominal injury caused by suspected abusive force admitted in Siriraj Hospital between May 2001 and July 2006 are reviewed. The first case is a six-year old boy who had liver laceration grade III at segment II and III. The history of trauma was refused by his parents initially. At last, the patient confessed that he was hit by the mother’s boy friend. The second case is a-10-month old girl who was operated for traumatic rupture in the 3rd part of the duodenum (90% circumference) as well as hematoma at the root of mesentery and ligament of Trietz following shopping with her family without history of traumatic event. Chest X-ray showed multiple old fractures at left posterior 6th, 7th, 8th ribs as well as a callus formation at the costochondral junction of the right 7th rib. Bone survey also demonstrated laminated periosteal reaction of the right tibia from previous fracture. The third case is a 3-year-old boy with intramural duodenal hematoma located between the 2nd part of the duodenum and the D-J junction. The patient told that he was stepped upon during lying down by his grandmother who has abused him many times before.

Conclusion: Child abuse is suspected in a case of conflict between physical examination findings and history of the accidental events, especially physically damage than the mechanism of injury. The patterns of inflicted injury are also discussed in this publication. Injury to the duodenum is unusual in the pediatric trauma patients but more commonly is the result of child abuse. Diagnosis and treatments of various types of duodenal injury including intramural duodenal hematoma are elucidated in this article.