An isolated perforation of the jejunum caused by child abuse. A case report.

Presented is the case of a 10-month-old boy who died of general peritonitis due to an isolated perforation of the proximal jejunum. The autopsy findings included multiple bruises and abrasions inflicted at different times, probable bite marks, an old cerebral contusion tear, malnutrition, and an involution of the thymus, this evidence cumulatively suggesting that the decedent was a battered child. The abdomen showed a general peritonitis, and the wall of the jejunum was ruptured on the antimesenteric surface, 2 cm from the duodenojejunal junction (the ligament of Treitz). Microscopically, the ruptured area showed a linear rent in the mucosa and muscularis, and the narrow necrotic lesion was surrounded by normal-appearing bowel tissue. Therefore, it appeared that an external force had compressed the jejunum against the spine, thus rupturing the jejunum near the duodenojejunal junction, a point of fixation.