Abstract text (incl. references and figure legends)
Case history: A 28 year old female with no past medical history was a front-seat passenger restrained with a seat belt in a car involved in a high velocity front end collision road traffic accident.
Clinical findings: On arrival to Emergency department of regional hospital she was haemodynamically stable. Abdominal examination revealed pain in lower abdomen and bruises above iliac crist billaterally.
Investigation/results: Laboratory tests revealed anemia and leukocytosis. X-ray of cervical spine, chest and pelvis excluded fractures. Computed tomography scan of thorax and abdomen showed moderate amount of free fluid in abdomen, intraperitoneal haematoma and contusion of abdominal wall, fracture of the first vertebra of the lumbar spine and fracture of the 11th left rib.
Diagnosis: A diagnosis of polytrauma and intraabdominal injury was made.
Therapy and Progression: Initial damage-limitation laparotomy revealed total rupture of both rectus muscles without laceration of the skin, haematomas of mesenterium and omentum, perforations of jejunum and sigmoid colon, multiple deserosations of the ileum and contusions of the bladder. Resection of sigmoid colon and jejunum both with latero-lateral anastomosis as well as the reconstruction of abdominal wall were performed. Postoperative course was complicated by dehiscence of sigmoid colon anastomosis and stercoral peritonitis which required re-laparotomy, resection of anastomosis, formation of terminal sigmostomy and Vacuum Assisted Closure therapy. 6 months later reconstruction of intestinal continuity was performed.
Comments: Closed rupture of the rectus abdominis muscle secondary to seatbelt trauma is rare. Our case highlights the need for suspicion, investigation and subsequent surgical management of intra-abdominal injury following identification of this rare consequence of seatbelt trauma.
References:Two cases of intestinal injuries due to seat belt without seat belt sign; Necdet Özçay et all; J Surg Case Rep. 2018 Nov; 2018(11):rjy298.
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