Duodenal hematoma in infancy and childhood: Changing etiology and changing treatment

Abstract

It is estimated that between 2300,000 and 4,000,OOO cases of active child abuse occur in the United States annually [I], and estimated deaths due to child abuse vary from 2,000 [2] to 50,000 annually [I]. The extreme variation in estimates is due to the difficulties inherent in proving or disproving child abuse. The child is either too young to testify on his own behalf or too frightened to do so. The abusive adult is not apt to admit to the abusive act, and those who live with him or her will assume a protective posture toward the abuser, thus denying all such allegations. Although the number of reported cases of intramural duodenal hematoma is increasing, there has been no consistent reportage of the association of active child abuse with this injury. Some of the case reports indicate “trauma of unknown etiology.” Such injuries may, in retrospect, be due to child abuse [3-81. In 1969 we reported our experience with seven patients who were treated for intramural duodenal hematoma [9]. Traumatic injury was denied by the parents of one patient, and in another the details of the trauma were not available. In retrospect, these two patients may have been injured by an abusive adult; however, at the time the manuscript was completed none of the patients was recognized as having been actively abused. During the subsequent seven years (1969-1977) eight patients have been treated for duodenal hematoma at the Childrens Hospital of Los Angeles. A retrospective review of these patients forms the basis of the present report.