Pancreatitis and the battered child syndrome. Report of 2 cases with skeletal involvement

Two cases of pancreatitis associated with the trauma of child abuse are reported. In the first case the skeletal survey was initially negative but the child later showed widespread roentgen evidence of intramedullary necrosis and periosteal new bone reaction. These lesions healed without treatment. In the second patient, the pancreatitis was accompanied by ascites and subsequently by bile peritonitis, duodenal obstruction, and a bile-filled abscess in the pancreas. This patient had skeletal fractures. The clinical problems of these 2 patients emphasize the need not only to relate pancreatitis to the battered child syndrome but also to distinguish between the bone changes due to direct trauma and those related to pancreatitis.