Gastric hematoma and pneumatosis in child abuse.

Abstract

A 21 -month-old girl was brought to the emergency department, unresponsive and hypotensive. Physical examination revealed multipIe bruises, lacerations, and human bite marks on the abdomen and back. Mild erythema around the vaginal introitus was present. Urinalysis showed a large quantity of myoglobin. Radiologic workup included a normal chest radiograph, cranial CT, and skeletal survey. Abdominal CT performed shortly after admission showed low-density intraperitoneal fluid, gastric distension, and gastric antral thickening due to an intramural hematoma (Fig. 1A). An upper gastrointestinal examination showed passage of contrast material into the duodenum without evidence of duodenal hematoma (Fig. 1B). After hydration, the patient became alert and active. However, on the second day after admission, she had increasing abdominal tendemess. The previously normal WBC count rose to 20 x 10 /l with a shift to the left. Repeated abdominal radiographs and abdominal CT scans were remarkable for air within the gastric wall as well as for gastric distension and antral hematoma (Fig. 1C). The patient was treated with IV antibiotics and was monitored closely in the intensive care unit. An upper gastrointestinal examination performed 1 0 days after admission showed resolution of the hematoma but persistence of air within the gastric wall. A follow-up upper gastrointestinal examination done 17 days after admission showed resolution of the gastric pneumatosis. Discussion