Enlarging on the Child Abuse Injury Spectrum Dr Kempe's marginal comment in the November 1975 issue prompts reference to another example of an unusual manifestation of injury related to child abuse. A previous report of this case emphasized the relationship between pancreatitis and lytic bone lesions, without particular attention to its resulting from child abuse.1 Report of a Case.\p=m-\A3\m=1/2\-year-oldgirl was brought to the emergency room semiconscious by her father who alleged that she had bumped her face on the dashboard of his car when he had stopped the car suddenly in traffic. The entire left side of her face was deeply ecchymotic, and her left eye was swollen shut. She appeared semiconscious, but responded to stimulation and verbal instruction.Other acute findings were ecchymoses of the back and abdomen, hypotension, oliguria, proteinuria, microscopic hematuria, pyuria, metabolic acidosis, gastrointestinal bleeding, azotemia (blood urea nitrogen, 60 mg/100 ml), hypocalcemia with seizures (serum calcium, 6.7 mg/100 ml), elevated levels of serum glutamic oxaloacetic transaminase (2,960 sigma units), serum glu¬ tamic pyruvic acid transaminase (2,140 units), serum amylase (1,000 units/100 ml; normal, less than 150), and thickened duo¬ denal and jejunal folds seen on roentgenographic contrast studies.By the second hospital day, the presence of pancreatitis was evident, and fever asso¬ ciated with pyuria, bacteriuria, and abdom¬ inal distension prompted institution of antibiotic therapy. Fever and leukocytosis persisted despite antibiotic therapy, and a liver scan demonstrated a significant focus of hypoperfusion on the posterolateral aspect of the right lobe. Abdominal explo¬ ration on the 15th day of hospitalization showed a mesenteric inflammatory mass containing caseous and purulent material that yielded aerobacter species on culture; diffuse mesenteric calcifications; enlarged, firm pancreas; and a right hepatic lobe hematoma. Colonie resection was neces¬ sary for complete removal of the mesenter¬ ic mass. Fever disappeared by the fourth postop¬ erative day, and she seemed on her way to complete recovery. Two weeks after surgery, swelling of the dorsum of the right foot was evident. Subsequent radiologic examinations showed multiple lytic lesions on the bones of the feet, hands, and several of the long bones. During the next three weeks, the number of such bone lesions was in excess of 300. After multiple futile attempts to identify a cause for these lesions, it was determined that they were most likely the result of intramedullary fat necrosis secondary to the osseous effects of pancreatitis.2"4 In all, the child was hospitalized for approximately six months. Her bone le¬ sions had almost completely healed eight months after discharge from the hospital; one year after discharge, she had only residual irregularities of metaphyses, most evident in the distal tibial metaphyses.Comment.-This case illustrates viv¬ idly the potential for severe multi¬ system involvement in physical child abuse and especially...
