Visceral injury in battered children: a changing perspective.

Abdominal or lower thoracic visceral injury was present in 14 of 69 children (20.3%) examined after suspected physical abuse. Of these, 10 were hemodynamically stable and examined with abdominal computed tomography (CT); four were hemodynamically unstable, taken directly to surgery, or died in the emergency room. In the group studied with CT, injuries to solid abdominal organs were most common (hepatic [n = 5], splenic [n = 3], renal [n = 1], adrenal [n = 1], and pancreatic [n = 1]) followed by pulmonary contusion or laceration (n = 2) and pneumoperitoneum due to duodenal transection (n = 1). No additional radiographic abnormalities were noted in five of these children. In the group not studied with CT, injuries to the intestinal tract and mesentery were most common (n = 3), followed by solid organ injury (hepatic [n = 1] and renal [n = 1]) and pulmonary contusion (n = 1). Intestinal, mesenteric, and pancreatic injuries were associated with a poor outcome. CT should be the examination of choice in abused children with suspected intraabdominal injury.