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A Case of Child Physical Abuse With a Rolling Pin Insertion, Resulting in Bladder and Rectal Perforation
Insights
This case report details a rare instance of child physical abuse causing bladder and rectal perforations from a rolling pin. This highlights the critical need for prompt diagnosis in nonaccidental trauma cases.
Area of Science:
- Pediatric Surgery
- Forensic Medicine
- Child Abuse Research
Background:
- Visceral injuries in nonaccidental trauma can be challenging to assess, often necessitating urgent surgical intervention.
- Accurate diagnosis is crucial for appropriate management and legal proceedings in cases of suspected child abuse.
Observation:
- A child presented with acute abdomen and intraperitoneal free fluid on ultrasonography, suggestive of visceral injury.
- Exploratory laparotomy revealed bladder and rectal perforations, requiring surgical repair.
Findings:
- The perforations were attributed to the insertion of a rolling pin into the rectum by the stepfather, a unique mechanism of inflicted injury.
- This represents the first reported case in English literature of rectal and bladder perforation caused by a rolling pin insertion.
Implications:
- This case underscores the importance of considering nonaccidental trauma in pediatric patients with unexplained abdominal injuries.
- Forensic evaluation and child protective services involvement are vital for uncovering abuse and ensuring child safety.
- Highlights a novel injury pattern requiring awareness among medical professionals dealing with pediatric trauma.
Abstract:
Visceral injuries are not uncommon in nonaccidental trauma and often require emergent operative intervention. However, sometimes it can be difficult to assess the extent of injury. In this report, we present a case of child physical abuse resulting in bladder and rectal perforations, which was initially referred to our hospital as acute abdomen with intraperitoneal free fluid on ultrasonography. An exploratory laparotomy revealed the perforations and surgical repair was performed. The patient was evaluated by the Hospital Child Protective team and it was revealed that bladder and rectum perforations were due to insertion of rolling pin into the rectum by the stepmother. The child was discharged home uneventfully with a temporary colostomy. We believe that this is the first reported case in the English literature of inflicted perforation of the rectum and bladder through insertion of a rolling pin.