Duodenal injuries in the very young: Child abuse?
ABSTRACT Duodenal injuries in children are uncommon but have been specifically linked with child abuse in case reports. Owing to the rarity of the diagnosis, few studies to date have looked at the association between duodenal injuries and mechanism in younger child. We hypothesize that duodenal injuries in the very young are significantly associated with child abuse.
This investigation is a retrospective cohort study of patients admitted with duodenal injuries at one of six Level I pediatric trauma centers. All institutions had institutional review board approval. The trauma registries were used to identify children aged 0 year to 5 years from 1991 to 2011. Multiple variables were collected and included age, mechanism of injury, type of duodenal injury, additional injuries, mortality, and results of abuse investigation if available. Relationships were analyzed using Fischer's exact test.
We identified 32 patients with duodenal injuries with a mean age of 3 years. Duodenal injuries included duodenal hematomas (44%) and perforations/transections (56%). Of all duodenal injuries, 53% resulted in operation, 53% had additional injuries, and 12.5% resulted in death. Of the 32 children presenting with duodenal injuries, 20 were child abuse patients (62.5%). All duodenal injuries in children younger than 2 years were caused by child abuse (6 of 6, p = 0.06) and more than half of the duodenal injuries in children older than 2 years were caused by child abuse (14 of 26). Child abuse-related duodenal injuries were associated with delayed presentation (p = 0.004). There was a significant increase in child abuse-related duodenal injuries during the time frame of the study (p = 0.002).
Duodenal injuries are extremely rare in the pediatric population. This multi-institutional investigation found that child abuse consistently associated with duodenal injuries in children younger than 2 years. The evidence supports a child abuse investigation on children younger than 2 years with duodenal injury.
Epidemiological study, level III.
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ABSTRACT: Battered child syndrome can refer to children exposed to harmful, non-accidental and preventable physical treatment by those are responsible for their care which prevents the child's physical, cognitive and spiritual development. A 28 months old boy was submitted to hospital due to abdominal blunt trauma. He had been firstly applied to Isparta Children Hospital by his parents with the complaint of fever. In the first examination, he was conscious, his general condition was poor there was respiratory acidosis, and neck stiffness was present. There were several fresh traumatic lesions on his face and left arm. His complaints were thought due to meningitis and antibiotics were started. He was transported to Suleyman Demirel University Hospital after a day because of vomiting, abdominal pain, tender, distended and silent abdomen, and air-fluid levels in direct abdominal X-rays. An old fracture of the right 9th rib was detected with chest X-ray in university hospital. Additionally, abdominal ultrasound scan showed distended bowel loops filled with fluid. Laparotomy revealed a complete rupture of the junction of the third and fourth parts of the duodenum and several hemorrhagic regions on bowel loops. The patient was discharged after 42 days. This case report described the case through both medical and legal processed in Turkey.Journal of Forensic and Legal Medicine 06/2008; 15(4):259-62. DOI:10.1016/j.jflm.2007.10.001 · 0.99 Impact Factor
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ABSTRACT: To emphasize the severity of the underlying injury which may not be realized during the initial patient admission to the emergency department. A retrospective case note review of children admitted to our institution with the severe abdominal injury. Eight children were identified with the severe abdominal injury secondary to the trauma from a bicycle handlebar that needed special care in the intensive care unit. All injuries were due to blunt trauma. The mean delay from the time of the accident to the time of presentation was 34.5 hours. All patients had an imprint of the handlebar edge on the hypochondrium. There were 3 pancreatic lacerations, 1 duodenal laceration, 1 jejunal laceration, 1 liver laceration, 1 abdominoinguinal laceration that all required open surgery, and 1 duodenal hematoma that resolved in 4 weeks follow-up period. The patients who required open surgery were evaluated with computed tomographic scans before surgery. Children with an imprint made by the handlebar edge on the abdominal wall or give a clear history of injuries by a bicycle handlebar should be treated with great care. Early computed tomography evaluation may help to reduce the morbidity resulting from the delay in diagnosis of injuries to the internal organs.Pediatric emergency care 08/2009; 28(4):357-60. DOI:10.1097/PEC.0b013e3181acd30f · 0.92 Impact Factor
Australian and New Zealand Journal of Surgery 06/1998; 68(5):380-2. DOI:10.1111/j.1445-2197.1998.tb04779.x