Seatbelt-related injury – blunt transection of the anterolateral abdominal wall with evisceration

Abstract text (incl. references and figure legends)

Closed ruptures of the abdominal wall following seatbelt related trauma are uncommon and the incidence has been estimated at 1%. Whilst seatbelts have been responsible for a decreasing mortality and decreased severity of injuries from road traffic accidents, seatbelt related injury patterns arise from the transfer of kinetic energy to the abdominal wall and internal visceral organs. The presence of rupture of rectus abdominis muscle secondary to seatbelt injury should raise the suspicion of intra-abdominal injury.

We report a case of 20 year old male patient who presented with a complete disruption of the entire anterolateral abdominal wall, following the seatbelt injury in a high speed motor vehicle collision. Abdominal computed tomography (CT) scan and further 3D modelation revealed the complete disruption of bilateral abdominal wall musculatures including traumatic abdominal wall hernia with hemoperitoneum and visceral injury. The patient was presented with signs of acute abdomen, a seatbelt sign and visible evisceration to the subcutaneous space, upon which the decision was made to perform emergency laparotomy. The patient had an abdominal wall disruption along the seatbelt sign, injuries of small bowel and colon coecum were also observed. The damage to small bowel mesentery and infarction of small and large bowel required intestinal resection. The patient underwent abdominal wall reconstruction by primary closure of the defect with absorbable monofilament sutures. During six months of follow-up no complications occurred.

Transection of the rectus resulting from seatbelt injury highlights considerable amount of force transferred to the extra-abdominal compartment. This should raise suspicion of injury to intra-abdominal structures. 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.

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