In abdominal injury due to NAT, the external examination may be normal. Thus, a high index of suspicion is required, especially in cases of associated inflicted injury. It has been noted that as few as 12% of children with inflicted abdominal injuries will have bruising of the abdominal wall.119 Of concern, abusive abdominal injury has a higher morbidity and mortality rate than nonabusive abdominal injury. 119 Blunt injury to the liver and intestine are the most frequent injuries in NAT. Additionally, NAT is the leading cause of duodenal perforation, which rarely occurs due to accidental injury.119 Unusual injuries (such as isolated adrenal injury) should raise suspicion for NAT as well.118
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