Esophageal perforation preceding fatal closed head injury in a child abuse case

Area of Science:

• Pediatric surgery
• Forensic pathology
• Child abuse recognition

Background:

• Esophageal perforations in neonates and infants are rare but serious injuries.
• Trauma, both accidental and non-accidental, is a common cause of esophageal perforation in this age group.
• Unexplained injuries warrant a high index of suspicion for non-accidental trauma.

Observation:

• A case of extensive esophageal perforation in a 15-day-old infant with an unclear mechanism of injury is presented.
• The infant later presented at 3 months of age as a victim of fatal child abuse, specifically a closed head injury.
• The severity of the esophageal injury was inconsistent with the initially unclear or potentially misrepresented history.

Findings:

• Extensive esophageal perforation in infants necessitates careful evaluation of the injury mechanism.
• A discrepancy between the reported history and the observed injury severity strongly suggests the possibility of child abuse.
• Thorough social investigation is crucial when non-accidental trauma is suspected.

Implications:

• This case highlights the importance of considering child abuse in cases of severe esophageal perforation in infants, even with an initially unclear etiology.
• Medical providers must be vigilant in assessing for non-accidental trauma when presented with severe injuries in young children.
• Prompt and thorough investigation can aid in protecting vulnerable children and ensuring appropriate interventions.