Delayed Presentation of Jejuno-Jejunal Fistula With Stricture After Physical Child Abuse
Adil Z Solaiman1, Afif N Kulaylat, Mary C Santos
1From the *Department of Pediatrics, Divisions of †Pediatric Surgery, ‡Pediatric Radiology, and §Anatomic Pathology, Penn State Hershey Medical Center, Hershey, PA.
Insights
Child abuse can cause subtle small intestinal injuries. Delayed diagnosis is common, but surgical repair of jejunal strictures and fistulas can fully resolve symptoms.
Area of Science:
- Pediatric Surgery
- Child Abuse
- Gastrointestinal Injury
Background:
- Small intestinal injury is rarely documented as a consequence of child abuse.
- Subtle clinical signs and symptoms often delay diagnosis of these injuries.
Observation:
- A 3-year-old boy with severe blunt abdominal trauma due to physical child abuse was initially managed nonoperatively.
- He later presented with recurrent nonspecific abdominal symptoms requiring further investigation.
Findings:
- Diagnostic laparoscopy revealed a jejunal stricture and a proximal jejuno-jejunal fistula.
- Surgical resection of the affected jejunal segment led to complete symptom resolution.
Implications:
- Delayed presentation of small intestinal injury should be considered in children with persistent abdominal symptoms and a history of physical abuse.
- Even without specific abnormalities on initial imaging, suspicion for these injuries is warranted.
Abstract:
Small intestinal injury is seldom described in the context of child abuse. Signs and symptoms are subtle, often leading to delays in diagnosis. We describe a 3-year-old boy initially admitted with severe blunt abdominal trauma from physical child abuse. He was successfully managed nonoperatively. The child was then hospitalized several times for nonspecific abdominal symptoms until diagnostic laparoscopy discovered a jejunal stricture with a proximal jejuno-jejunal fistula. Symptoms fully resolved after resection. Delayed presentation of small intestinal injury should remain on the differential diagnosis in the evaluation of persistent abdominal symptoms in a child with a prior history of physical abuse, even if imaging studies do not reveal specific abnormalities.
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