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Perforated Small Intestine: A Case of a Delayed Presentation of an Intra-Abdominal Injury in a Pediatric Patient With
Gregory M Taylor1, Jonathan P Zygowiec2, Laurie C Wallace3
1Indiana University School of Medicine, Ball Memorial Hospital, Department of Emergency Medicine, Muncie, IN, USA.
Insights
The seatbelt sign can indicate delayed intra-abdominal injuries after a car crash. This case highlights the importance of observing patients with seatbelt signs for potential internal damage.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Abdominal Imaging
Background:
- Seatbelt use is associated with a distinct injury pattern known as the "seatbelt syndrome."
- The "seatbelt sign," characterized by abrasions and bruising, suggests potential underlying trauma.
Observation:
- A 17-year-old female presented after a motor vehicle collision with a seatbelt sign but was hemodynamically stable.
- Initial imaging showed only an abdominal wall contusion, and the patient was admitted for observation.
Findings:
- Delayed presentation of intra-abdominal injury occurred 12 hours post-admission.
- Repeat imaging revealed free fluid and air, necessitating an exploratory laparotomy.
Implications:
- This case underscores the potential for delayed intra-abdominal injuries in patients with a seatbelt sign.
- Extended observation periods may be crucial for identifying subtle or delayed injuries following blunt abdominal trauma.
Abstract:
With the use of seatbelts comes a unique injury profile that has been called "the seatbelt syndrome." The classically described "seatbelt sign" has become a pattern of injury, describing potential underlying damage. As a clinician, clues to the underlying damage follow a thorough physical examination including the removal of all clothing to locate abrasions and bruises to the skin that potentially follow a seatbelt pattern. Delayed presentation of an intra-abdominal injury in the setting of a seatbelt sign has been well documented; however, the question is how long to observe these patients. We present the case of a 17-year-old woman involved in a motor vehicle collision who presented to the emergency department (ED) hemodynamically stable with a lower abdominal wall seatbelt sign. Her initial imaging revealed only an abdominal wall contusion. She was admitted for observation. Approximately 12 h later she started developing abdominal pain, and by 14 h abdominal distention, with repeat imaging showing free fluid and free air. She was taken to the operating room for an exploratory laparotomy and was ultimately discharged back home on day 7.
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