Duodenal hematoma from a fall down the stairs.

Blunt abdominal trauma is not a common finding in abused children. However, there is a high rate of mortality associated with this type of injury. Recognizing the presentation of a child with abusive abdominal injuries is crucial for healthcare providers. Often these children are too young to provide a history of the injury, the caretaker accompanying the child may provide you with a misleading history or a history of minor trauma, and the child's symptoms may range from abdominal pain to vomiting to septic shock, making the diagnosis difficult. The child's anatomy puts him/her at risk for intra-abdominal injury from blunt force. They have less musculature and fat than adults and their rib cage is horizontally oriented, allowing organs to extend beyond the costal margin. Duodenal injuries are extremely uncommon in children because of the retroperitoneal location and a substantial amount of force is necessary to injure this area of abdomen. Understanding the different injury patterns and various mechanisms required to cause abdominal injury is important in determining accidental injury from nonaccidental injury.