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Intra-abdominal and intrathoracic injuries are identified in a small but important fraction of abused children. These injuries can be deadly and can significantly affect the plausibility of an offered history for other injuries. Clinical signs of abdominal injury (tenderness, bruising, distention, altered bowel sounds) are relatively specific but relatively insensitive. Hepatic transaminases (AST and ALT) can identify abdominal injuries that are missed by clinical examination alone and should be obtained in children < 5 years old with concern for physical abuse and a significant injury. When AST or ALT are > 80 IU/L, abdominal CT with intravenous (IV) contrast should be obtained to identify intra-abdominal injury.
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Significant intra-abdominal injuries are uncommonly the result of short falls or stairway falls, although relatively low-energy injuries with a direct blow to the abdomen (eg, a fall onto handlebars) can produce significant injuries.
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Management and Disposition
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Most solid organ injuries in well-appearing children are self-limited, but hollow viscus injuries, pancreatic injuries, and vascular injuries have high likelihood of deterioration and require early surgical consultation. Children with identified intra-abdominal or intrathoracic injuries require admission for observation and surgical consultation. The identification of abusive intra-abdominal or intrathoracic injuries should prompt screening for other abusive injuries with a careful physical examination, skeletal survey (for children < 24 months old), and neuroimaging (for children < 6 months old or with signs of brain injury).
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