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01.12.2015 | Case report | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

Seatbelt sign in a case of blunt abdominal trauma; what lies beneath it?

Zeitschrift:
BMC Surgery > Ausgabe 1/2015
Autoren:
Michail G. Vailas, Demetrios Moris, Stamatios Orfanos, Chrysovalantis Vergadis, Alexandros Papalampros
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MV, DM, SO, CV, AP conceived of the study, and participated in its design and coordination and helped to draft the manuscript. AP has given final approval of the version to be published. All authors read and approved the final manuscript.

Authors’ information

Michail G. Vailas:
Degree in Medicine (M.D), Degree in Pharmacy, General Surgery resident, First Surgical Department, Athens University School of Medicine, “Laiko” General Hospital, Agiou Thoma 17, Athens, 11527, Greece
Demetrios Moris:
MD, PhD, First Surgical Department, Athens University School of Medicine, “Laiko” General Hospital, Agiou Thoma 17, Athens, 11527, Greece
Stamatios Orfanos:
MD, First Surgical Department, Athens University School of Medicine, “Laiko” General Hospital, Agiou Thoma 17, Athens, 11527, Greece
Chrysovalantis Vergadis:
MD, Radiology Department, “Laiko” General Hospital, Agiou Thoma 17, Athens, 11527, Greece
Alexandros Papalampros:
MD, PhD, Lecturer, First Surgical Department, Athens University School of Medicine, “Laiko” General Hospital, Agiou Thoma 17, Athens, 11527, Greece

Abstract

Background

The reported incidence of hollow viscus injuries (HVI) in blunt trauma patients is approximately 1 %. The most common site of injury to the intestine in blunt abdominal trauma (BAT) is the small bowel followed by colon, with mesenteric injuries occurring three times more commonly than bowel injuries. Isolated colon injury is a rarely encountered condition. Clinical assessment alone in patients with suspected intestinal or mesenteric injury after blunt trauma is associated with unacceptable diagnostic delays.

Case presentation

This is a case of a 31-year-old man, admitted to the emergency department after being the restrained driver, involved in a car accident. After initial resuscitation, focused assessment with sonography for trauma examination (FAST) was performed revealing a subhepatic mass, suspicious for intraperitoneal hematoma. A computed tomography scan (CT) that followed showed a hematoma of the mesocolon of the ascending colon with active extravasation of intravenous contrast material. An exploratory laparotomy was performed, hemoperitomeum was evacuated, and a subserosal hematoma of the cecum and ascending colon with areas of totally disrupted serosal wall was found. Hematoma of the adjacent mesocolon expanding to the root of mesenteric vessels was also noted. A right hemicolectomy along with primary ileocolonic anastomosis was performed. Patient’s recovery progressed uneventfully.

Conclusion

Identifying an isolated traumatic injury to the bowel or mesentery after BAT can be a clinical challenge because of its subtle and nonspecific clinical findings; meeting that challenge may eventually lead to a delay in diagnosis and treatment with subsequent increase in associated morbidity and mortality. Isolated colon injury is a rare finding after blunt trauma and usually accompanied by other intra-abdominal organ injuries. Abdominal ‘seatbelt’ sign, ecchymosis of the abdominal wall, increasing abdominal pain and distension are all associated with HVI. However, the accuracy of these findings remains low. Diagnostic peritoneal lavage, ultrasound, CT and diagnostic laparoscopy are used to evaluate BAT. Although CT has become the main diagnostic tool for this type of injuries, there are few pathognomonic signs of colon injury on CT. Given the potential for devastating outcomes, prompt diagnosis and treatment is necessary and high clinical suspicion is required.
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