WOFAPS 2025 8th World Congress of Pediatric Surgery

Sabina Anderson, Agne Mikneviciute, Dalius Malcius

Lithuanian University of Health Sciences, Kaunas clinics

Introduction. Child abuse includes physical, emotional, sexual abuse, and neglect, often occurring within families. Despite affecting over 1 billion children annually, it's frequently underrecognized. Medical staff face challenges due to vague symptoms, unclear histories, and lack of training in detection. A rare and severe case of abdominal trauma in a child is presented, with suspected familial abuse.

Case presentation. A 2-year-old girl was admitted to the emergency department due to impaired consciousness, with suspected sepsis, intoxication, and head injury. Due to the unknown medical history, abdominal trauma was not initially considered. However, an abdominal ultrasound and CT scan were later performed, revealing hemoperitoneum, bowel rupture, and kidney infarction. The patient underwent urgent surgery. Intraoperatively, a complete tear of the distal part of the duodenum was identified, along with mesenteric rupture and active bleeding from the superior mesenteric artery. Approximately 50 cm of the jejunum showed mild signs of ischemia; however, resection was deferred at that time, and duodenojejunostomy was performed. The kidney was not removed, and thrombectomy was not feasible. On postoperative day four, a relaparotomy was performed due to clinical deterioration. Bowel necrosis was identified, and resection with primary end-to-end anastomosis was carried out. A left nephrectomy was also performed due to persistent renal artery thrombosis and renal necrosis. The patient’s condition gradually improved thereafter, and she was discharged home after 33 days. An investigation by the authorities revealed that the child had been abused by her mother’s boyfriend, who was subsequently convicted.

Conclusion: This case highlights the complexity and severity of pediatric abdominal trauma, involving multiple organ injuries and vascular complications. In the presence of an unclear medical history, abdominal trauma should always be considered—especially when child abuse is suspected. Prompt diagnosis, timely surgical intervention, and meticulous postoperative management were critical to the patient’s recovery.