Major blunt abdominal trauma due to child abuse

Arthur Cooper, Thomas Floyd, Barbara Barlow, Maria Niemirska, Tephen Ludwig, Toni Seidl, James O’Neill, John Templeton, Moritz Ziegler, Arthur Ross, Rajinder Gandhi, Robert Catherman

Research output: Contribution to journalArticlepeer-review

112 Scopus citations


We reviewed 15 years’ experience with childhood trauma at two hospitals in different cities, one a city hospital, the other a children’s hospital, to learn the extent, circumstances, presentations, and consequences of major blunt abdominal trauma due to child abuse. Some 10,000 children admitted to these hospitals for treatment of injuries from 1972 through 1986 provided the basis for the study; the incidence and severity of pediatric trauma at the two hospitals was similar, in that 13% of the visits to both hospitals’ emergency rooms were for trauma, of which 5% resulted in admission. Major blunt abdominal trauma due to child abuse accounted for 22 of these cases, six at the former, 16 at the latter, and represented <0.50% of all abused children seen at both institutions. The average age was 24 mo; 14 were boys and eight were girls. In only two instances was the family unit intact; in both, the child was abused by the babysitter. Otherwise, the father, or the mother’s “boyfriend,” was responsible. Overall mortality was 45%, and was related both to type of injury and presenting signs. Of one who presented with an epigastric mass due to a pancreatic hematoma, none died; the pseudocyst which subsequently developed resolved on bowel rest and TPN. Of three who presented with bilious vomiting due to duodenal hematoma, none died; one required operative evacuation. Of five who presented with peritonitis due to duodenojejunal rupture, one died; this child presented >24 hr following injury in profound septic shock. Of three who presented with hypovolemia due to moderate hemorrhage, none died; the former two were managed conservatively. However, of six who presented in profound shock due to massive hemorrhage, all but one died, mortality being directly related to blood loss. Four were dead on arrival, all of whom showed evidence of intra-abdominal hemorrhage found at autopsy to exceed 50% of estimated blood volume. Failure of the parent(s) to seek immediate medical attention delayed treatment by a mean of 13 hours; this delay obviously contributed to the high mortality. Major blunt abdominal trauma due to child abuse is a serious, but fortunately, infrequent problem which carries an unacceptably high mortality. The similarity of findings between the two patient groups studied indicates both the widespread nature of child abuse, and the need to suspect the diagnosis whenever a child presents with unexplained shock or peritonitis, especially if there is anemia or bilious emesis.

Original languageEnglish (US)
Pages (from-to)1483-1487
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number10
StatePublished - Oct 1988

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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