Isolierte Gastrointestinalverletzungen durch körperliche Mißhandlung

Abstract

Three cases of fatal blunt abdominal trauma due to physical abuse are reported. Rupture of intestine and mesentery occurred after maltreatment by kick, battering, shaking, and throwing off on a mattress. The different mechanisms leading to these injuries are discussed. Small bowel lesions secondary to direct laceration are recognized to be more probable than due to indirect trauma.

Homicidal blunt abdominal trauma with isolated laceration of the small bowel mesentery

“…In this way, lacerations of the mesenteric vessels resulted in fatal intra-abdominal and retroperitoneal hemorrhages. These cases thus seem to confirm the assumption that injuries of the small bowel and mesentery are caused by direct rather than indirect trauma (Vock 1980;Vock et al 1980).…”

“…Fall from a height may also result in mesenteric lacerations, generally with other lesions, however (Vock 1980). The mechanism of these injuries may be either compression between an external force and the lumbar spine or a shearing on the root of the small bowel mesentery, with avulsion of the superior mesenteric vessels themselves or their primary branches (Killen 1964;Percy 1970;Williams and Kirkpatrick 1971;McCullough 1976;Vock et al 1980). In the two present cases, which are almost identical, the mechanism was a direct sagittal force which compressed the mesentery against the lordotic lumbar spine.…”

“…Only extremely rarely, however, have such lesions been recorded as resulting from a homicidal act. Vock et al (1980) described a 2.5-year-old boy who was punched and kicked and whose death was attributed to intraabdominal and retroperitoneal hemorrhages from a mesenteric laceration. In this case, as well as in the present two cases, the lesions resulted from direct rather than indirect trauma.…”

Non-traumatic rupture of the superior mesenteric vein with hemoretroperitoneum

“…The majority of mesenteric lacerations have occurred in car or aircraft accidents and have been attributed to the lapstrap of seat belts [4,5] or to the rim of a steering wheel [10,11]. The mechanism of these injuries may be either compression between an external force and the lumbar spine or shearing at the root of the small bowel mesentery, with a~lsion of the superior mesenteric vessels [4,10,12].…”