Seat-belt injuries

Seat Belt Aortic Dissection: A Case Report

Eighteen-year-old restrained male driver involved in a flip over motor vehicle accident resulting in a seatbelt injury triad ( rectus abdominis muscle disruption, injury to the sigmoid colon and infra-renal aortic dissection). The patient did well after the surgical resection of the sigmoid colon, repair of the rectus abdominis muscle and endovascular repair of the aorta. Our objective is to shed light on this potentially fatal injury. 

Gastrointestinal Traumatic Injuries: Gastrointestinal Perforation

The abdomen is a big place even in a small person. Gastrointestinal trauma can result in injury to the stomach, small bowel, colon, or rectum. Traumatic causes include blunt or penetrating trauma, such as gunshot wounds, stabbings, motor vehicle collisions, and crush injuries. Nontraumatic causes include appendicitis, Crohn disease, cancer, diverticulitis, ulcerative colitis, blockage of the bowel, and chemotherapy. The mechanism of injury will affect both the nature and severity of any resulting injuries. Treatment must address the critical and emergent nature of these injuries as well as issues that affect all trauma situations, which include management of hemodynamic instability.

Seat belt syndrome: Delayed or missed intestinal injuries, a case report and review of literature

INTRODUCTION

Seat belt injuries are not uncommon. The use of seat belts is associated with a unique injury profile collectively termed "the seat belt syndrome". The aim is to aid in the early diagnosis of seat belt injuries.

CASE PRESENTATION

Two different patients presented to the emergency after sustaining a motor vehicle accident. Both were the drivers, restrained and had a frontal impact. On presentation they were hemodynamically stable with mild tenderness on the abdomen and the abdominal computed tomography (CT) did not show any signs of bowel or mesenteric injuries. The signs of peritonitis became obvious after 24h in one case and after 3 days in the other.

DISCUSSION

Early diagnosis provides better outcomes for patients with seat belt injuries, but this remains a challenge to trauma surgeons. The typical findings of peritonitis might not be present initially. The presence of abdominal wall ecchymosis (seat belt sign) increases the chance of intraabdominal injuries by eight folds.

CONCLUSION

Clinical signs of intestinal injuries might not be obvious on presentation. In the presence of seat belt sign the possibility of bowl injury must be suspected. Admit the patient for observation even if no clinical or radiological findings are present at presentation.

Abdominal injury and the seat-belt sign

OBJECTIVE

To report on: 1. Prevalence of seat-belt sign in motor vehicle accident victims with abdominal injuries; 2. Prevalence of intestinal injuries in patients with seat-belt sign; and 3. Spectrum of abdominal injuries in a population with high usage of three-point restraints.

METHODS

A retrospective chart review was conducted in an adult tertiary-referral hospital from January 1992 to August 1998. Patients were identified from International Classification of Disease-9 codes for abdominal wall and intra-abdominal injuries.

RESULTS

The seat-belt sign was present in 60/99. The proportion of intestinal injuries in patients with and without seat-belt sign were 9/60 and 0/39, respectively (P = 0.01). In the 25 patients with intra-abdominal injuries, there were 10 hepatic, 8 splenic, 9 intestinal and 4 retroperitoneal injuries.

CONCLUSION

The seat-belt sign is indicative of an increased risk of intestinal injury, which is difficult to detect with no single test providing reliable diagnosis. Other intra-abdominal and retroperitoneal injuries may also occur, which are more readily diagnosed on computed tomography scan or focused abdominal utlrasound when available, but are no more frequent in patients with the seat-belt sign than those without.

The “Seat Belt Mark” Sign: A Call for Increased Vigilance among Physicians Treating Victims of Motor Vehicle Accidents

The use of seat belts is shown to cause a specific pattern of internal injuries. Skin bruise corresponding to the site of the seat belt is known as the “seat belt mark” (SBM) sign and is associated with a high incidence of significant organ injuries. No study has yet defined the exact incidence of injuries requiring intervention at the presence of this sign. The objective of this study was to find the incidence of surgically correctable injuries in belted car occupants with a SBM sign and to define strategies of early detection and treatment of such injuries. The prospective study included consecutive patients involved in road traffic accidents who were admitted at an academic Level I trauma center. Of 650 car occupants, 410 (63%) were restrained and 77 (12%) had a SBM across the abdomen, chest or neck. The injuries of these 77 patients were compared with the injuries of belted patients without an SBM sign. Of patients with SBMs, 9 per cent had neck bruises, 32 per cent had chest bruises, 40 per cent had abdominal bruises, and 19 per cent had bruises in multiple sites. No significant neck injuries were detected. Three patients were found to have myocardial contusion, and 10 patients had intra-abdominal injuries (predominantly bowel and mesenteric lacerations) requiring laparotomy. There was a near 4-fold increase in thoracic trauma (22.5% versus 6%; P = 0.01) and a near 8-fold increase in intraabdominal trauma (23% versus 3%; P < 0.0001) between the groups of patients with and without SBMs. The presence of the SBM sign should alert the physician to the high likelihood of specific internal injuries. Routine laparotomy or mandatory evaluation by specific diagnostic tests is not justified; rather, a high index of suspicion with a low threshold for appropriate diagnostic evaluation and/or surgical exploration should be maintained for the optimal management of such patients.

General surgical injuries in survivors of the M1 Kegworth air crash. Nottingham, Leicester, Derby, Belfast Study Group

The general surgical consequences of the M1 Kegworth air crash are described. Considering the severe nature of the injuries sustained by the survivors, surprisingly few required general surgical intervention. Intra-abdominal injuries were rare despite the abdomen's apparent vulnerability to injury; only five laparotomies were performed. However, 30 (34%) of survivors demonstrated significant bruising from lap belts and 13 patients had haematuria. The majority of operations carried out were orthopaedic related.

Transverse disruption of the abdominal wall--a tell-tale sign of seat belt related hollow viscus injury

A pattern of injuries has been observed in five (5) female front seat passengers wearing seat belts. All were involved in high speed frontal impact motor vehicle accidents on country roads. Varying degrees of abdominal wall disruption involving fat, fascia or muscle, were universally associated with hollow viscus injury and right-sided rib fractures. Most patients had mesenteric or omental tears, flail chests and left clavicular injuries. Intimal tears of the distal aorta, right breast injuries and spinal injuries were also observed. The hollow viscus and mesenteric injuries may result from direct crushing, sudden rises of intraluminal pressure, or shearing forces acting at points of mesenteric attachments. At laparotomy it is recommended that necrotic or contused fascia and muscle be excised with primary abdominal closure and contused fat be excised or curetted and suction drainage applied to the subcutaneous tract. Abdominal wall disruption from seat belt trauma reflects the forces involved on impact and should alert the surgeon to the observed pattern of internal injuries.

Isolated injury to the intestine from blunt abdominal injury

Isolated injury to the intestine due to blunt abdominal trauma is an uncommon event. Since the haemodynamic disturbance which accompanies injury of the liver or spleen is absent the initial symptoms and signs may be very slight, or obscured by injuries of the abdominal wall, musculoskeletal or nervous systems. We present four cases which illustrate pitfalls in management. A high index of suspicion is essential if morbidity and mortality are to be reduced to a minimum. Abdominal radiography and peritoneal lavage are useful aids when diagnosis is in doubt.

Fatal cervical dislocation related to wearing a seat belt: a case report

A case of fatal cervical dislocation in a front seat passenger restrained by a retractable three-point belt is described. A biomechanical and technical analysis is given.

[Multiple fractures of the atlas with delayed fatal thrombosis of vertebral artery following "whiplash" injury of the neck (author's transl)]

Report of the case of a 62 year old male, who died in a car crash on his way home from duty, when he had a frontal collison with annother car at a speed of about 70 km per hour. After the collision, the car had completely turned over to its wheels. As the man had put on the seat belts, he had not been cast against the front window so that there were no head injuries. Following an unconsciousness of about ten minutes the patient recovered quickly and was already fully oriented when arrived at hospital. No neurological symptoms could be substantiated. He only suffered from pain of the neck and had a marked swelling of the left side of the neck. A burstin fracture of the atlas vertebra (Jefferson-fracture) was overlooked in routine X-rays of the craniovertebral region. Eight days after the accident, the hitherto "well improving" patient died suddenly and unexpectedly. The autopsy revealed an obstructing thrombosis of the left vertebral artery, less than 24 hours old. The wall of the artery showed numerous dissecting ruptures with intramural bleedings.

Subclavian artery rupture (an unusual seat-belt injury)

A case of blunt injury to the subclavian artery in the absence of bony injury or dislocation sustained while wearing a seat belt is described. Its rarity and diagnostic pitfalls are discussed. The mechanism of the injury is analysed. The value of angiography is emphazided. It is suggested that, even in the presence of collateral circulation, exploration and repair should be undertaken.