Abdominal Injuries

Visceral manifestations of NAI are uncommon and considered to contribute 2-4% of injuries in NAI (37,38). However, visceral injuries carry a high morbidity and mortality (estimated mortality of 40-50%) and are the second most common cause of fatal child abuse because of the shear force of trauma, delay in recognition of injury because of frequent lack of signs and symptoms, and delay in recognition of NAI (38,39).

Injuries arise mainly from blunt trauma (punching, kicking, trampling, or stamping) or sudden acceleration/deceleration injuries (swinging or throwing a child into a solid object) and include contusion, laceration, and rupture of solid or hollow viscera. The duodenum, jejunum, pancreas, and liver are common sites of injury in abdominal NAI. Colonic or rectal injuries are associated with sexual abuse (38).

Vomiting, abdominal distension, pain, and shock may be presenting features. Other features of NAI and skeletal injury may provide clues to the underlying etiology. Immediate surgery may be necessary.

Suggested investigations include full blood count, blood biochemistry, pancreatic and liver enzymes, plain, abdominal, and chest X-ray (free air or free fluid), ultrasound, CT, and gastrointestinal contrast studies, where indicated.

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