%0 Journal Article
%T Seatbelt syndrome associated with an isolated rectal injury: case report
%A Ashraf F Hefny
%A Yousef I Al-Ashaal
%A Ahmed M Bani-Hashem
%A Fikri M Abu-Zidan
%J World Journal of Emergency Surgery
%D 2010
%I BioMed Central
%R 10.1186/1749-7922-5-4
%X Despite the decreasing mortality in restrained victims of motor vehicle collisions (MVC), a new type of injury related to seatbelt usage has emerged. Seatbelt sign is the linear ecchymosis of the skin caused by the seatbelt following MVC [1]. Seatbelt syndrome is defined as a seatbelt sign associated with a lumbar spine fracture and a bowel perforation. An isolated rectal perforation due to seatbelt syndrome is extremely rare. There is only one case reported in the Danish literature and non in the English literature [2].A 48-year old front seat restrained passenger was involved in a head-on collision. He has presented with lower abdominal pain and back pain. Seatbelt mark was seen transversely across the lower abdomen (Fig 1). There was partial weakness of the muscle power of the right lower limb. Initial trauma CT scan was normal except for a burst fracture of L5 vertebra. There was narrowing of more than 60% of the spinal canal, three columns fracture involving the body and right lamina with posterior bulging of a bone fragment into the canal (Fig 2). This fracture was internally fixed using a pedicle screw instrumentation and a laminectomy on the same day of admission through a posterior approach to achieve extension and distraction (Fig 3). The patient continued to have abdominal pain and distention which became evident on the third day. Bedside ultrasound has shown distended small bowel loops without evidence of intraperitoneal fluid. Repeated abdominal CT scan with intravenous contrast has shown free intraperitoneal air. Furthemore, there was distended thickened small bowel loops. There was a low attenuation area anterior to the left psoas muscle suggesting of inflammatory changes but no free intraperitoneal fluid could be demonstrated. There was bilateral pleural effusion more on the left side (Fig 4). Exploratory laparotomy has revealed the presence of free intrapeitoneal air but there was no faecal soiling. The small bowel was hugely distended, thickened an
%U http://www.wjes.org/content/5/1/4