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Victorian Forensic Paediatric Medical Service

Visceral injury including abdominal injury

  • VFPMS Guideline: Forensic investigation for visceral injury

    Visceral injuries are injuries to all internal organs. Abdominal injuries are described more frequently than thoracic injuries. Abdominal injuries in young children in the absence of a history of significant trauma are rare. Many abusive abdominal injuries, in particular hepatic lesions, are occult. Remembering to search for possible visceral trauma in the context of investigations for physical abuse is important.

    Key points:

    • Abdominal injuries are a significant cause of morbidity and mortality in abused children.
    • Visceral injuries may be occult and their diagnosis delayed because injury to internal organs was initially not suspected.
    • Almost every organ in the body has been reported as having been injured through child abuse.
    • Injury to the small intestine in young children (less than 5years-old and particularly in those less than 2years-old) who have not experienced motor vehicle accidents warrants serious consideration for abuse.
    • In infants with suspected Abusive Head Trauma, abdominal injuries should be considered.

    Investigations:

     When significant physical abuse is suspected (in any form), VFPMS recommends laboratory screening for occult abdominal injury 
    • Pancreatic enzymes (including amylase and lipase)
    • Liver Function Tests
    • Urine dipstick (for haematuria)
    • FBE (for occult blood loss)
    • Fibrinogen
     Consideration should be given to radiologic investigations 

    Abdominal CT Scan with contrast is the investigation of choice that should be obtained if the following concerns are present.

    • Possible paralytic ileus (absent/hypoactive bowel sounds)
    • Possible intra-abdominal haemorrhage
    • Significantly abnormal laboratory results (for example AST or ALT >80IU/L). Serious consideration should be given to CT or MRI when AST > 200IU/L and/or ALT > 125IU/L)  
    • ≥2 abnormal abdominal laboratory results
    • Concerning physical examination findings (including abdominal bruising, distension or tenderness)