Inferior mesenteric artery laceration associated with blunt abdominal trauma with Casper's sign in a physically abused child: An autopsy case and literature review

There have been few studies of the death of children secondary to child abuse-related abdominal compression, and the detailed pathophysiology of such deaths is therefore unknown. The autopsy findings of a 3-year-old boy who died of hemorrhagic shock due to non-accidental severe blunt abdominal trauma were compared to those of children who died of other non-accidental abdominal injuries. Old and acute subcutaneous hemorrhages, abrasions, and scars were present all over the subject's body. No superficial injuries were found on the ventral midline, but a minor hemorrhage was found in the subcutaneous fat tissue, as well as in the rectus abdominis muscle. The intraperitoneal space contained 450 mL of blood, including coagulated blood. There was a tear in the transverse mesocolon and a crush injury in the small bowel mesentery. The inferior mesenteric artery was transected 0.5 cm from the aortic root. The transverse colon was necrotic, with hemorrhages in the mucosa. Since various organs were ischemic, the cause of death was determined to be blood loss from the inferior mesenteric artery injuries. Blunt abdominal trauma in children usually causes organ damage and intestinal injury, but because it is caused on the posterior surface of the mesentery, vascular injury should also be considered, and an autopsy should be performed. In the case of child abuse-related deaths, damage to the skin surface may not always be present; therefore, imaging tests, histopathological examinations, and biochemical tests should be performed with a focus on the gross anatomy to determine the cause of death and pathology.