The nature of the injury together with a history lacking a good explanation for it is concerning for non-accidental injury.

At 2 years of age, a child becomes too big to be shaken and the typical injuries associated with this (among others, metaphyseal corner fracture, rib fractures, subdural hematomas) are becoming infrequent.

Pancreatic transection and rupture of lymphatics are known to occur in the context of non-accidental injury.

Of note, a third of all post traumatic pancreatitis is abuse related.