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An isolated perforation of the jejunum caused by child abuse. A case report
1Department of Legal Medicine, Faculty of Medicine, Kagoshima University, Japan.
Insights
A battered child case highlights jejunal perforation as a fatal injury. Autopsy revealed blunt force trauma consistent with child abuse, leading to peritonitis and death.
Area of Science:
- Forensic Pathology
- Pediatric Traumatology
Background:
- Child abuse can manifest in severe internal injuries.
- Jejunal perforation is a rare but critical consequence of abdominal trauma.
Observation:
- Autopsy of a 10-month-old boy revealed signs of severe child abuse, including bruises, abrasions, and a cerebral contusion.
- The infant presented with general peritonitis secondary to an isolated perforation of the proximal jejunum.
Findings:
- The jejunal rupture occurred on the antimesenteric surface near the duodenojejunal junction.
- Microscopic examination showed a linear rent in the mucosa and muscularis, suggesting external force compression against the spine.
Implications:
- This case underscores the importance of recognizing non-accidental trauma in pediatric cases presenting with abdominal injuries.
- Jejunal perforation should be considered in the differential diagnosis of unexplained abdominal deaths in children.
- Forensic investigation must correlate external and internal findings to establish the mechanism of injury.
Abstract:
Presented is the case of a 10-month-old boy who died of general peritonitis due to an isolated perforation of the proximal jejunum. The autopsy findings included multiple bruises and abrasions inflicted at different times, probable bite marks, an old cerebral contusion tear, malnutrition, and an involution of the thymus, this evidence cumulatively suggesting that the decedent was a battered child. The abdomen showed a general peritonitis, and the wall of the jejunum was ruptured on the antimesenteric surface, 2 cm from the duodenojejunal junction (the ligament of Treitz). Microscopically, the ruptured area showed a linear rent in the mucosa and muscularis, and the narrow necrotic lesion was surrounded by normal-appearing bowel tissue. Therefore, it appeared that an external force had compressed the jejunum against the spine, thus rupturing the jejunum near the duodenojejunal junction, a point of fixation.