title: Delayed Presentation of Jejuno-Jejunal Fistula With Stricture After Physical Child Abuse.
abstract: Small intestinal injury is seldom described in the context of child abuse. Signs and symptoms are subtle, often leading to delays in diagnosis. We describe a 3-year-old boy initially admitted with severe blunt abdominal trauma from physical child abuse. He was successfully managed nonoperatively. The child was then hospitalized several times for nonspecific abdominal symptoms until diagnostic laparoscopy discovered a jejunal stricture with a proximal jejuno-jejunal fistula. Symptoms fully resolved after resection. Delayed presentation of small intestinal injury should remain on the differential diagnosis in the evaluation of persistent abdominal symptoms in a child with a prior history of physical abuse, even if imaging studies do not reveal specific abnormalities.
authors.affiliation: From the *Department of Pediatrics, Divisions of †Pediatric Surgery, ‡Pediatric Radiology, and §Anatomic Pathology, Penn State Hershey Medical Center, Hershey, PA.
authors.forename: Adil Z
authors.initials: AZ
authors.lastname: Solaiman
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.forename: Mary C
authors.initials: MC
authors.lastname: Santos
authors.forename: Dorothy V
authors.initials: DV
authors.lastname: Rocourt
authors.forename: Sosamma T
authors.initials: ST
authors.lastname: Methratta
authors.forename: Karmaine
authors.initials: K
authors.lastname: Millington
authors.forename: Chandran P
authors.initials: CP
authors.lastname: Alexander
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D003251:Constriction, Pathologic; D003952:Diagnostic Imaging; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D007583:Jejunum / Q000293:injuries*; D010535:Laparoscopy; D008297:Male; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery