The use of seatbelts has increased significantly in the last twenty years, leading to a decrease in mortality from road traffic accidents (RTA). However, this increase in seatbelt use has also led to a change in the spectrum of injuries from RTA; abdominal injuries, particularly intestinal injuries have dramatically increased with the routine use of seatbelts. Such intestinal injuries frequently result from improper placement of the “lap belt”. We present 3 cases in which passengers wearing a seatbelt sustained significant devascularisation injuries to the small bowel requiring emergency surgical intervention. A high index of suspicion is crucial in such cases to prevent delays in diagnosis that can lead to severe complications and adverse outcomes. It is evident that while advocating seatbelt use, the importance of education in correct seatbelt placement should also be a focus of public health strategies to reduce RTA morbidity and mortality. 1. Introduction The mortality of passengers in road traffic accidents (RTA) is decreasing as a result of increased use of seatbelts; according to a survey by the National Roads Authority (NRA) in Ireland, compliance with seatbelt wearing has increased from 53% in 1991 to 86% in 2005 [1]. However, the use of seatbelts is associated with a unique injury profile collectively termed “the seatbelt syndrome” which includes injuries to the intestinal viscera, tears and perforations of the gastrointestinal tract and its mesentery and lumbar fracture dislocations [2]. These injuries are more prevalent in the paediatric population due to ill-fitting lap belts [3]. However, they also occur in adults, particularly when a seatbelt is worn incorrectly due to suboptimal placement, inadequate securing or patient factors such as obesity and poor positioning/slouching. We report 3 cases from Mayo General Hospital which demonstrate significant intra-abdominal/mesenteric injury sustained through seatbelt use in RTA. 2. Cases The three cases are summarized in Table 1. Table 1: Clinical Cases—presentation, investigation and management. All patients were passengers in high impact RTAs; two were front seat passengers and one rear passenger. All three were wearing a three point harness system seatbelt. All patients had a “seatbelt sign” consisting of contusions, petechiae and a band-like pattern of abrasions across the lower abdomen. Two patients had associated orthopaedic injuries, one of which was a lumbar spine injury in keeping with the “seatbelt syndrome” [2]. All patients required emergency laparotomy and bowel resection as a result
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