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Delayed onset of intestinal obstruction in children after unrecognized seat belt injury
J M Hardacre1, K W West, F R Rescorla
1Department of Surgery, Indiana University Medical Center, Indianapolis.
Insights
Child lap belt injuries can cause delayed intestinal obstruction weeks after an accident. Early diagnosis is crucial for children experiencing nausea and bilious vomiting post-trauma.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Child safety seats and seat belts reduce head injuries in motor vehicle accidents.
- However, a rise in intestinal perforations and delayed obstructions from ischemic strictures has been observed.
Observation:
- This report details two children with delayed intestinal obstruction due to "seat belt syndrome."
- Both presented with bilious emesis 3-6 weeks after unrecognized lap belt injuries.
Findings:
- Laparotomy revealed volvulus around an omental band attached to a resolving mesenteric hematoma in both cases.
- This volvulus caused a stricture requiring surgical resection and anastomosis.
Implications:
- Post-traumatic intestinal obstruction should be suspected in children with nausea and bilious emesis after motor vehicle accidents involving lap belts.
- Recognizing this association can lead to timely diagnosis and treatment, improving outcomes for pediatric trauma patients.
Abstract:
The increased use of child safety seats and seat belt restraints has significantly reduced the incidence of severe head injuries associated with motor vehicular accidents. However, an increase in the number of both acutely recognized intestinal perforations and delayed obstructions due to ischemic strictures has been noted. This report describes two children with delayed onset of intestinal obstruction related to the "seat belt syndrome" who presented with bilious emesis 3 to 6 weeks following an unrecognized lap belt injury. At laparotomy, a volvulus around an omental band adherent to a resolving traumatic mesenteric hematoma was the basis of the obstruction in both cases. The volvulus resulted in a stricture in each instance that required resection and end-to-end anastomosis. The diagnosis of posttraumatic intestinal obstruction should be suspected in children who develop nausea and bilious emesis following motor vehicular accidents in which they were wearing lap belts.