Complex Presentation of Seatbelt Syndrome.

Abstract

Background: Seat belt usage can lead to injuries like the "Seat-belt sign," an abdominal bruising from compression forces. When coupled with internal or lumbar injuries, this forms "Seat Belt Syndrome.

Objective: This report details the case of a young male involved in a frontal collision, presenting with severe multiple complicated injuries including abdominal trauma with multiple damage control surgeries.

Case presentation: The patient presented to the emergency department after road traffic accident with a seat belt sign, Exploratory laparotomy unveiled extensive injuries, including complete jejunal transaction, avulsion of the terminal ileum, sigmoid mesentery avulsion, and rectosigmoid junction degloving with left anterolateral muscle destruction forming a traumatic hernia. Surgical interventions included jejunal resection and anastomosis, ileocecal limited resection and anastomosis, lastly Hartmann procedure and left high colostomy creation. Subsequent procedures addressed complications, in form of anastomotic leakage managed with resection of the ileocolic anastomosis and ileostomy creation, Vacuum-Assisted Closure dressing, and biological mesh placement to manage abdominal wall infection and dehiscence. After one year the patient underwent surgery for ileostomy and colostomy reversal, along with abdominal wall reconstruction using biosynthetic mesh.

Conclusion: Managing injuries involving the jejunum, ileum, and rectosigmoid requires careful surgical intervention, considering individual cases and surgeon judgment. Our experience highlights the need for a modification in the emergency room policies, advocating immediate computed tomography scans for patients with seat belt signs for early detection and improved outcomes.