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Non-accidental Trauma - Abdominal Manifestations

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 3 years ago
Updated: over 3 years ago
Tags: PEDS
Modality/Study Types: CT
Activities:
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History

Hemodynamically unstable toddler with holohemispheric left supratentorial subdural hematoma.


Case Images


Diagnosis

Non-accidental Trauma – Abdominal Manifestations

Findings

CT – Axial and coronal images of the abdomen show laceration of the caudate lobe, periportal edema, mural hematoma of the distal duodenum, and hemoperitoneum.

Discussion

Injury patterns are often key in recognizing non-accidental trauma (NAT). Skeletal, intracranial and orbital injuries are common and have been well described. Visceral injuries are less common and often overlooked, but they can be life threatening. The mortality of abusive abdominal injuries is twice as high as accidental abdominal injuries. Any solid organ can be injured in the setting of NAT. Liver, small bowel, spleen and pancreas are the most commonly injured. Typical injuries include lacerations, contusions and hematomas. Liver and splenic injuries are noted with equal frequency in accidental and non-accidental trauma. On the other hand, duodenal injuries have not been reported in children less than 4 years old with accidental trauma. Therefore, duodenal injuries, including mural hematoma, perforation and transection, in a child less than 4 years of age strongly indicates NAT. Pancreatic injuries can lead to pancreatitis and subsequent pseudocyst formation. Renal injuries do not appear as often. The increased incidence of pancreatic and duodenal trauma means visceral compression against the spine is a common etiology.

Reference

Maguire SA, Upadhyaya M, Evans A, et al. A systematic review of abusive visceral injuries in childhood-their range and recognition. Child Abuse Negl. 2013 Jan 7. pii: S0145-2134(12)00254-2. doi: 10.1016/j.chiabu.2012.10.009. [Epub ahead of print].

Ng CS, Hall CM, Shaw DG. The range of visceral manifestation of non-accidental injury. Arch Dis child. 1997;77:167-74.

Contributor

Ryan Konwinski, MD



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