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Stricture of the duodenum and jejunum in an abused child
P Shah1, K E Applegate, C Buonomo
1Section of Pediatric Radiology, Cleveland Clinic Foundation, OH 44195, USA.
Insights
Child abuse can cause severe abdominal injuries, including duodenal hematoma and perforations. This case highlights a rare complication of blunt abdominal trauma leading to duodenal obstruction.
Area of Science:
- Pediatric Surgery
- Abdominal Trauma
- Child Abuse Forensics
Background:
- Child abuse is a significant cause of pediatric injury.
- Blunt abdominal trauma in children can lead to serious gastrointestinal complications.
- Duodenal hematomas and perforations are known but uncommon injuries.
Observation:
- A case of pediatric abdominal injury secondary to child abuse is presented.
- The patient exhibited a duodenal hematoma and contained perforations of the duodenum and proximal jejunum.
- Initial evaluation included CT scan and upper GI series.
Findings:
- Persistent nausea and vomiting despite conservative management.
- A repeat upper GI series revealed high-grade duodenal obstruction after 3 weeks.
- Exploratory laparotomy identified a calcified, fibrotic mesentery and strictures in the distal duodenum and proximal jejunum.
Implications:
- This case describes an unusual complication of blunt abdominal trauma in the context of child abuse.
- Highlights the importance of considering severe gastrointestinal injury in suspected child abuse cases.
- Suggests potential for long-term sequelae such as mesenteric fibrosis and strictures following pediatric blunt abdominal trauma.
Abstract:
We report a case of abdominal injury secondary to child abuse in which the child had both a duodenal hematoma and contained perforations of the duodenum and proximal jejunum. These injuries were evaluated by both CT scan and upper gastrointestinal (GI) series. The child's nausea and vomiting persisted despite conservative treatment; after 3 weeks a repeat upper GI series demonstrated high-grade duodenal obstruction. An exploratory laparotomy was performed and a calcified, fibrotic mesentery and strictures in the distal duodenum and proximal jejunum were found. To our knowledge, this unusual complication of blunt abdominal trauma has not been described in association with child abuse.