By Anthony J. Brown, MD
NEW YORK (Reuters Health) – In young children, particularly
those under age 5, injuries to the small intestine are more
likely to be caused by child abuse rather than a fall or other
accident, a study shows.
Half of children with abdominal injuries due to abuse have
damage to the small intestine, new research indicates. By
contrast, with accidental abdominal injuries, the small bowel
is affected in no more than a fifth of cases.
Abuse should be considered in young children with
small-bowel injury, the authors say, especially if the
explanation given for the injury is a fall. “In our study,
there weren’t any cases of small bowel injury due to falls in
children under 5 years of age,” senior author Dr. Jonathan R.
Sibert, from Cardiff University in the UK, told Reuters Health.
He and colleagues compared abdominal injuries sustained by
20 children exposed to abuse, 112 involved in road-traffic
accidents, and 52 involved in falls, according to a report in
The Lancet this week.
Sixteen of the abused children were younger than 5 years of
age, the report indicates. By comparison, just 14 of the
children involved in traffic accidents and 3 of the fall
victims were younger than 5 years.
Eleven of the abused children (55 percent) had gut
injuries, including 10 cases of small bowel damage and 1 case
of gastric perforation. The number of children with gut
injuries in the traffic accident and fall groups were 28 (21
percent) and 5 (10 percent), respectively. In children younger
than 5 years, crash-related gut injuries were rare and
fall-related gut injuries were unheard of.
The other abdominal organs injured in the abused group
included the liver in seven patients, spleen in six, pancreas
in two, and kidney in two.
Sibert urges doctors to “think of abuse when small bowel
injury is seen in a child under 5 and if you have an abused
child, consider the possibility of abdominal injury, even in
the absence of obvious bruising.”
SOURCE: The Lancet July 16, 2005.
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