Rupture of segmental dilatation of the sigmoid colon resulting from blunt force to the abdomen in a child

Abstract A four-year-old child died nine hours after he was found lying crying in the yard of a nursery school during morning playtime. Although no-one had witnessed any related event, time-lapse images recorded by a security camera suggested that he had fallen forward onto the ground while running with a hula hoop he had been using to simulate a car steering wheel. Since the cause of death was not determined by the doctor at the general hospital to which the boy had been transferred, and police investigation suspected that the hula hoop had struck the boy in the abdomen, a medicolegal autopsy was performed to clarify the cause of death. Prior to autopsy, postmortem computed tomography (PMCT) revealed free intraperitoneal fluid, free intraperitoneal gas, and segmental sigmoid colon dilatation, suggesting perforation or rupture of the bowel and subsequent peritonitis. At autopsy, external examination demonstrated no bruising on the abdomen, but internal examination revealed bleeding in the subcutaneous fatty tissue of the abdominal wall, rupture in the region of the sigmoid colon showing segmental dilatation, and disseminated peritonitis. 3D volume-rendered images constructed from the PMCT data suggested that a direct blow to the abdomen might have caused injury to the sigmoid colon by compressing it against the spine, and that the rupture could have been facilitated by the segmental dilatation. In the present case, reciprocity between autopsy and PMCT was useful for verifying rupture in an area of segmental dilatation of the sigmoid colon caused by blunt force to the abdomen.