title: Elasticity of abdominal wall vessels in children: clinical implications in child abuse.
abstract: BACKGROUND
  Abdominal trauma secondary to non-accidental injury is associated with high rates of morbidity and mortality. It has been noted that children who have suffered abusive abdominal injuries often lack abdominal wall bruising. We hypothesize that children have highly elastic vessels that stretch instead of rupturing when the abdomen is punched. Our study investigates the degree of elasticity in abdominal wall vessels in young children.
  
  
  METHODS
  Twenty children aged less than 5 years undergoing routine hernia repair or orchidopexy were included in our study. Subcutaneous vessels were identified during the procedures. The vessels were measured at resting length and when stretched to maximum length prior to rupture. Samples of the vessels were then collected for histological examination.
  
  
  RESULTS
  On average, we were able to stretch the vessels to 3.4 times their resting length without rupture. Histology revealed that the vessel walls contained a high amount of elastin.
  
  
  CONCLUSIONS
  We have demonstrated a high degree of elasticity in the abdominal wall vessels of young children. This may help to explain why children do not bruise when hit in the abdomen. Our findings have potential implications for both clinical practitioners and paediatric surgeons involved in child abuse cases.
authors.affiliation: Department of Paediatric Surgery, Wellington Children's Hospital, Wellington, New Zealand.
authors.forename: Lucy
authors.initials: L
authors.lastname: Goddard
authors.forename: Brendon
authors.initials: B
authors.lastname: Bowkett
authors.forename: Diane
authors.initials: D
authors.lastname: Kenwright
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis*; D034861:Abdominal Wall / Q000098:blood supply*; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D004548:Elasticity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009520:New Zealand; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*
keywords: abdominal injury; abdominal wall; blood vessel; child abuse; preschool child