Safe Place: The Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 2716 South St., Philadelphia, PA, 19146, USA.
Pediatr Radiol. 2021 May;51(6):1044-1050. doi: 10.1007/s00247-020-04944-2. Epub 2021 Mar 23.
Abusive intra-abdominal injuries are less common than other types of injuries, such as fractures and bruises, identified in victims of child physical abuse, but they can be deadly. No single abdominal injury is pathognomonic for abuse, but some types and constellations of intra-abdominal injuries are seen more frequently in abused children. Identification of intra-abdominal injuries can be important clinically or forensically. Injuries that do not significantly change clinical management can still elevate a clinician's level of concern for abuse and thereby influence subsequent decisions affecting child protection efforts. Abusive intra-abdominal injuries can be clinically occult, necessitating screening laboratory evaluations to inform decisions regarding imaging. Once detected, consideration of developmental abilities of the child, type and constellation of injuries, and the forces involved in any provided mechanism of trauma are necessary to inform assessments of plausibility of injury mechanisms and level of concern for abuse. Here we describe the clinical, laboratory and imaging evaluation of the abdomen in the setting of suspected child abuse.
虐待性腹部损伤比其他类型的损伤（如骨折和瘀伤）少见，这些损伤是儿童身体虐待受害者的特征，但它们可能是致命的。没有一种单一的腹部损伤是虐待的特征性表现，但一些类型和组合的腹部损伤在受虐待的儿童中更为常见。腹部损伤的识别在临床上或法医学上可能很重要。不会显著改变临床管理的损伤仍然可以提高临床医生对虐待的关注程度，从而影响后续影响儿童保护工作的决策。虐待性腹部损伤可能在临床上隐匿，需要进行筛选实验室评估，以告知有关影像学的决策。一旦发现，需要考虑儿童的发育能力、损伤的类型和组合，以及任何提供的创伤机制中涉及的力，以告知对损伤机制的可能性和对虐待的关注程度的评估。在这里，我们描述了疑似儿童虐待情况下腹部的临床、实验室和影像学评估。
