Seat-belt stomach transection in association with ‘Chance’ vertebral fracture

Abstract

Seat-belt stomach transection is a very rare injury. We report the first known survivor of this injury. The patient had also sustained a 'Chance' vertebral fracture'. Case reportA 20-year-old woman was admitted to hospital following involvement in a two car head-on collision. She was a front-seat passenger wearing an inertia-reel lap and shoulder type seat belt. On arrival in the Accident and Emergency Department she was complaining of abdominal pain. Blood pressure was 130/80mmHg and pulse rate 100 per minute. Abdominal examination revealed bruising across the centre of her abdomen and at the right anterior superior iliac spine. She had generalized tenderness with guarding. While being examined she vomited a large amount of fresh blood. At laparotomy the peritoneal cavity was filled with blood and food debris. The stomach had been completely transected just proximal to the pylorus. No other abdominal injuries were discovered. Gastroduodenal continuity was restored and the peritoneal cavity was copiously irrigated. On the second postoperative day she complained of back pain. Lateral X-rays of her lumbar spine showed splitting-apart of the neural arch and posterior aspect of the body of the second lumbar vertebra. On the anteroposterior views separation of the transverse and spinous processes was visible ( Figure I ) . DiscussionShamblin* and Dajee3 have previously reported seat-belt stomach transection in young adult women, both of whom died from exsanguination. A clinical finding in both cases was central abdominal bruising; the 'seat-belt sign'4. If this sign is accompanied by evidence of peritoneal irritation, however minimal, intra-abdominal injuries should be suspected and laparotomy undertaken promptly.Seat belt injury to the stomach is very rare because of the stomach's relatively protected position. The distal part of the stomach is vulnerable in deceleration, as shearing forces come into play at the 'free-fixed' junction with resultant transection. Alternatively, when the empty stomach is suddenly and forcibly compressed against the vertebral column by a seat belt, vertical transection of the stomach may occur.Visceral and vertebral injuries frequently co-exist and one must be wary of falsely attributing signs of reflex ileus to a vertebral fracture in the presence of intra-abdominal injury. The 'Chance' fracture is a true flexion fracture typically seen in high velocity collisions5. It is surprisingly stable and after an initial period of bed-rest, a plaster jacket is fitted. The prognosis is excellent. 5.

Total prepyloric transection of stomach and vertebral trauma: case report and review of the literature

“…Four cases of total prepyloric transection have been presented so far [2,[4][5][6]. Table 1 lists five patients, including our patient, with total prepyloric transection of stomach.…”

“…? Unknown a Wrong seat belt, the adult seat belt is designed for people above 150 cm, the girl was 135 cm Probable mechanism of stomach perforation was described by Dajee and MacDonald [4] and Carragher and Cranley [5]. Why only women were affected is unclear.…”

“…The first total pyloric transection was described in 1967 by Shamblin [3]. Subsequently, there were single cases presented by Dajje and MacDonald [4], Carragher and Cranley [5] and Whyte et al [6]. All the cases occurred in motor vehicle accident and only young women or girls were affected.…”

Traumatic prepyloric transection: unusual injury in a child

“…Seat-belt stomach transection is a very rare injury [2], especially in children. According to Nanji and Mock [3], most cases occur in the setting of motor vehicle trauma and the diagnosis is usually made at laparotomy, although the advent of CT scanners in the last decade has meant an increase in the preoperative diagnosis of pneumoperitoneum associated with HVI [4].…”

Chance-Type Fracture of L1 with Entrapment of the Cauda Equina

“…The association of thoracolumbar fractures and abdominal injuries after a motor vehicle accident is well documented [10,12,[16][17][18][19][20]. In the presence of Chancetype thoracolumbar flexion-distraction lesion, Anderson et al [12] noticed a life-threatening intraabdominal trauma in 65% of the patients.…”