Duodenal injuries in children: beware of child abuse

Non‐Sexual Abuse in Children

“…Bruises on the chest and back usually originate from punctual finger pressure. Deep visceral injuries with liver lacerations or rupture of the pancreas and duodenum may occur without visible external signs of violence over the abdomen (Kirschner and Wilson 2001;Ludwig 2001;Gaines et al 2004;Barnes et al 2005;Roaten et al 2005).…”

Lethal visceral traumatic injuries secondary to child abuse: A case of practical application of autopsy, radiological and microscopic studies

“…Delay in seeking care frequently contributes substantially to the high mortality as often these children are not seen until they have developed peritonitis, sepsis, or vascular collapse [3,[8][9][10][11]. In such cases, both the history and the physical examination may be vague and nonfocal, hampered by evasiveness on the part of the perpetrators and the delay in presentation [12]. Thus, abdominal injury is not the most common form of abuse-related injury, but it is highly lethal [3,7].…”

“…Overall, 65% of bowel perforations occur within 100 cm of the ligament of Treitz [11]. The retroperitoneal location of the duodenum provides it with a degree of protection [3,12]. Therefore, significant force must be applied to the area to result in perforation or haematoma [3,12].…”

“…The retroperitoneal location of the duodenum provides it with a degree of protection [3,12]. Therefore, significant force must be applied to the area to result in perforation or haematoma [3,12]. Bowel perforation may result from shearing forces produced by sudden deceleration tearing the bowel at the antimesenteric border close to its point of attachment to the posterior abdominal wall [7,12].…”

Hallazgos de necropsias en maltrato infantil en Bogotá, Colombia, entre el 2000-2005 y el 2011-2013

“…La lesión mesentérica es un trauma contundente que cizalla el órgano contra la columna vertebral, con dirección anteroposterior y de abajo arriba, caracterís-tico de los puños y las patadas [28], mientras que las lesiones hepáticas generalmente se producen por un trauma directo de adelante hacia atrás.…”