Bowel injury common with child abuse

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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, according to new research.

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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