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Esophageal perforation with mediastinal abscess in child abuse
1Department of Radiology, University of California, Davis Medical Center, Sacramento.
Insights
Child abuse can cause esophageal perforation, leading to mediastinitis and abscesses in infants. Consider esophageal injury in young children with unexplained neck swelling and breathing difficulties.
Area of Science:
- Pediatric Surgery
- Forensic Pathology
- Medical Toxicology
Background:
- Child abuse is a significant concern in pediatric healthcare.
- Esophageal perforations are rare in infants and young children.
- Mediastinitis and mediastinal abscesses are severe complications.
Observation:
- A 9-month-old girl presented with symptoms suggestive of mediastinitis and mediastinal abscess.
- The child was a victim of suspected child abuse and possible sexual assault.
- Cervical esophageal perforation was identified as the cause of the mediastinitis.
Findings:
- Esophageal perforation in infants can result from non-accidental trauma.
- Clinical signs include neck swelling, subcutaneous emphysema, and pneumomediastinum.
- Early recognition is crucial for timely intervention and improved outcomes.
Implications:
- Healthcare providers should consider esophageal injury in abusive head trauma cases.
- Forensic evaluation is important in suspected child abuse cases with these symptoms.
- This case highlights the need for awareness of non-accidental trauma as a cause of esophageal perforation in children.
Abstract:
A case of mediastinitis and mediastinal abscess due to cervical esophageal perforation in a 9/12 month old girl who was a victim of child abuse and possible sexual assault is reported. Injury to the hypopharynx or esophagus with child abuse as a possible etiology should be considered when an infant or young child presents with unexplained erythematous neck swelling, subcutaneous emphysema, pneumomediastinum and/or wide mediastinum.