Seatbelt injury to the abdominal aorta

Seatbelt injury to the abdominal aorta is a rare finding with an unresolved mechanism. We present a case in which a rear-seat passenger wearing a lap belt was involved in a motor vehicle accident. Injuries sustained included a contused abdominal aorta. At the time of aortic repair, the involved segment was found to be atheromatous, had an intimal tear, and a flap that caused complete occlusion. Graft replacement was carried out employing a 12-mm DeBakey woven dacron prosthesis, which restored satisfactory circulation to both lower limbs. The patient developed myoglobinemia and subsequently died due to multiple organ failure 19 days following the accident. Tearing against the vertebral column, and bowel loop entrapment, in high-speed deceleration have been implicated as injury mechanisms as well as impingement by the belt or metal buckle, in such injuries. Also, our patient had existing atheromatous plaque, which was ruptured.