The Role of Computed Tomography in the Diagnosis of Bowel Avulsion in Seat-Belt Injury: Report of a Case

Year 2019, , 499 - 501, 23.12.2019

Özlem Boybeyi

https://doi.org/10.12956/tchd.562168

Abstract

Seat-belt sign (SBS) is the pattern of thoraco-abdominal ecchymosis in distribution of seat-belt and considered to be strongly associated with intestinal injuries.  Herein, an 11-year-old boy who had bowel avulsion was presented to discuss the use of computed tomography (CT) in the diagnosis of seat-belt injury in children. An 11-year-old boy was brought to the emergency room because of high-speed motor vehicle crash. His general condition was good. He had mild abdominal tenderness and a seat-belt bruising on his belly. The first laboratory examinations, chest and abdominal X-rays revealed normal findings. Abdominal ultrasound showed minimal free fluid. Since physical examination revealed ongoing tenderness, CT was performed. A large defect in abdominal fascia and disruption in sigmoid colon integrity were detected in CT. The patient underwent emergent exploration revealing disruption in fascia and avulsion in small and large intestine. The postoperative course was uneventful. Seat-belt injury is a rare type of pediatric trauma and may cause severe bowel injury. The diagnosis of bowel avulsion due to seat-belt injury can be challenging in the absence of free sub-diaphragmatic air in abdominal X-rays. CT should be performed if other radiologic interventions are not compatible with the physical findings.

Keywords

Contusion, Thoracic injuries

Emniyet Kemeri Yaralanmasında Görülen Bağırsak Avülsiyonu Tanısında Bilgisayarlı Tomografi Kullanımı: Olgu Sunumu

Abstract

Emniyet kemeri işareti, emniyet kemeri seyrinde torako-abdominal ekimoz görülmesi olup bağırsak yaralanmalarıyla güçlü bir şekilde ilişkilidir. Burada, çocukluk çağı emniyet kemeri yaralanmalarının tanısında bilgisayarlı tomografinin (BT) kullanımı tartışmak amacıyla bağırsak avülsiyonu olan 11 yaşında bir hasta sunulmuştur. Yüksek hızlı trafik kazası nedeniyle 11 yaşında erkek hasta acil servise getirildi. Araçta hastanın emniyet kemerinin takılı olduğu öğrenildi. Genel durumu iyi olup fizik incelemede, batında hassasiyet ve emniyet kemeri izi şeklinde morluk vardı. Tam kan sayımı, idrar tahlili ve kan biyokimyasını içeren ilk tetkikler normal sınırlardaydı. Akciğer ve batın grafilerinde normal bulgular mevcuttu. Batın ultrasonografisinde sol kadranlarda minimal serbest sıvı vardı. Fizik incelemede batın hassasiyeti olduğundan BT çekildi ve batın fasyasında geniş defekt ve sigmoid kolon bütünlüğünde bozulma tespit edildi. Hasta acil ameliyata alındı ve fasyada defekt, ince ve kalın bağırsakta avülsiyon tespit edildi. Hastanın ameliyat sonrası izlemi sorunsuzdu. Emniyet kemeri yaralanması çocukluk çağının ender görülen bir yaralanma şeklidir ve ciddi bağırsak yaralanmasına neden olabilir. Emniyet kemerine bağlı bağırsak avülsiyonunun tanısı özellikle direk batın grafisinde diafragma altı serbest hava olmadığı durumlarda çelişkili ve zordur. Diğer radyolojik tetkikler fizik inceleme bulguları ile uyumsuz olduğunda tanı için BT yapılması önerilir. 

Keywords

Kontüzyon, Toraks travması

References

• 1. Garrett JW, Braunstein PW. The seat belt syndrome. J Trauma 1962;2:220-38.
• 2. Szadkowski MA, Bolte RG. Seatbelt syndrome in children. Pediatr Emer Care 2017;33:120-7.
• 3. Masudi T, McMahon HC, Scott JL, Lockey AS. Seat beltrelated injuries: a surgical perspective. J Emerg Trauma Shock 2017;10:70-3.
• 4. Santschi M, Lemoine C, Cyr C. The spectrum of seat belt syndrome among Canadian children: results of a two-year population surveillance study. Paediatr Child Health 2008;13:279-83.
• 5. Borgialli DA, Ellison AM, Ehrlich P, Bonsu B, Menaker J, Wisner DH, et al. Association between the seat belt sign and intra-abdominal injuries in children with blunt torso trauma in motor vehicle collisions. Academic Emergency Medicine 2014;21:1240-8.
• 6. Al-Ozaibi L, Adnan J, Hassan B, Al-Mazroui A, Al-Badri F. Seat belt syndrome: delayed or missed intestinal injuries, a case report and review of literature. Int J Surg Case Reports 2016;20:74-6.
• 7. Johnson MC, Eastridge BJ. Redefining the abdominal seatbelt sign: enhanced CT imaging metrics improve injury prediction. Am J Surg 2017;214:1175-9.
• 8. Ng AKT, Simons RK, Torreggiani WC, Ho SG, Kirkpatrick AW, Brown DR. Intra-abdominal free fluid without solid organ injury in blunt abdominal trauma: an indication for laparotomy. J Trauma 2002;52:1134-40.
• 9. Lutz N, Nance ML, Kallan MJ, Arbogast KB, Durbin DR, Winston FK. Incidence and clinical significance of abdominal wall bruising in restrained children involved in motor vehicle crashes. J Pediatr Surg 2004;39:972-5.
• 10. Chidester S, Rana A, Lowell W, Hayes J, Groner J. Is the ‘seat belt sign’ associated with serious abdominal injuries in pediatric trauma? J Trauma 2009;67:S34-6.
• 11. Makrin V, Wiesel O, Heller D, Klausner JM, Soffer D. Low probability of significant intra-abdominal injury in stable patients with abdominal ‘seat belt sign’. Eur J Trauma Emerg Surg 2009;35:403-6.
• 12. Stassen NA, Lukan JK, Carrillo EH, Spain DA, Richardson JD. Abdominal seat belt marks in the era of focused abdominal sonography for trauma. Arch Surg 2002;137:718-23.
• 13. Eberhardt CS, Zand T, Ceroni D, Wildhaber BE, La Scala G. The seatbelt syndrome - do we have a chance? Pediatr Emer Care 2016;32:318-22.
• 14. Paris C, Brindamour M, Ouimet A, St-Vil D. Predictive indicators for bowel injury in pediatric patients who present with a positive seat belt sign after motor vehicle collision. J Pediatr Surg 2010;45:921- 4.
• 15. Holmes JF, Lillis K, Monroe D, Borgialli D, Kerrey BT, Mahajan P, et al. Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med 2013;62:107-16.