Lethal visceral traumatic injuries secondary to child abuse: a case of practical application of autopsy, radiological and microscopic studies.
A 3-year-old boy child died at home. The circumstances of death appeared unclear to the police investigators and a medicolegal autopsy was carried out. External examination revealed diffuse ecchymoses of varying colours. Postmortem imaging using plain X-rays and multislice computed tomography (MSCT) was performed prior to autopsy and pathological study. These investigations revealed fractures at the posterior arch of the ninth left rib. No cerebral and pericerebral traumatic lesions were diagnosed. In the abdomen, haemoperitoneum and pneumoperitoneum secondary to duodenal perforation and liver laceration were observed. At autopsy, a complete pancreatic fracture and duodenal transection were noted, accounting for the MSCT appearance. Furthermore, autopsy revealed the presence of bilateral intramuscular intercostal haemorrhages and a fracture of the eighth left rib at its posterior arch. This case report illustrates the valuable assistance rendered by MSCT as well as its limitations in diagnosing abuse when a child dies in unclear circumstances.
Dedouit
Fabrice
F
Service de Médecine Légale, Centre Hospitalier Universitaire Rangueil, Avenue du Professeur Jean Poulhès, 31403 Toulouse Cedex 4, France. fabded2@hotmail.com
Mallinger
Béatrice
B
Guilbeau-Frugier
Céline
C
Rougé
Daniel
D
Rousseau
Hervé
H
Telmon
Norbert
N
D002649:Child Abuse; D002675:Child, Preschool; D004386:Duodenum / Q000293:injuries* / Q000473:pathology; D049429:Forensic Pathology; D006465:Hemoperitoneum / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D007416:Intestinal Perforation / Q000473:pathology*; D022125:Lacerations / Q000473:pathology; D008099:Liver / Q000293:injuries* / Q000473:pathology; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D010179:Pancreas / Q000293:injuries* / Q000473:pathology; D011027:Pneumoperitoneum / Q000473:pathology; D012253:Rib Fractures / Q000473:pathology*; D014057:Tomography, X-Ray Computed