Fatal child abuse-maltreatment syndrome; a case report

Abstract: Child abuse-maltreatment syndrome can be described as child death due to repeated episodes of physical abuse and neglect. Here we present a case of child physical abuse and neglect causing death due to duodenal perforation. A five year old boy was reported to have stomachache occurring one day before death. He was admitted to a private health clinic where he was discharged after an analgesic injection. Because of increasing complaints he was applied to the same clinic, afterwards sent to an Emergency Department where he died during resuscitation. At autopsy, external examination revealed several traumatic injuries and two bite marks of different age, while internal examination revealed 500 ml of dirty yellowishgreenish free liquid in abdominal cavity and a perforation 0.5 cm in diameter of the duodenum wall. Insufficient parental supervision in spite of continuous traumas strongly indicates negligence or intentional abuse by parents. Additionally, insufficient medical follow up, besides; not disclosing the injuries on child's body adds medical malpractice aspect to this case. Key Words: child abuse-maltreatment syndrome, physical abuse of child, child neglect, domestic violence, death A s a recently recognized entity, Child abuse-maltreatment syndrome involves repeated episodes of intentional trauma and negligence of a child, which can result in chronic consequences or death. This syndrome includes a combination of maltreatment types. Examinations of such cases reveal various types of injuries of different age. In most cases, healed older injuries and findings of negligence are accompanied by a recent fatal injury that is the immediate cause of death Inflicted traumatic brain injury is the leading cause of death due to child abuse, while blunt abdominal trauma takes place as the second commonest cause of death among abused children. Duodenal injuries secondary to blunt trauma are rare but generally life threatening A case of death due to child abuse-maltreatment syndrome with multiple types of maltreatment is presented because of its interesting history and dramatic findings accompanied by medical malpractice. Case presentation The presented case, a five year-old boy, was previously diagnosed with mental retardation, attention deficit and hyperactivity disorder and had rehabilitation because of these issues. He had been followed up in a rehabilitation service until the family terminated the treatment. The subject was separated from his biological mother and had been living with his biological father, step mother and two step-siblings wh