Seat-Belt Injury: Injury of the Abdominal Aorta

The development and use of the lap-type seat belt has reduced the number of serious injuries (4) to automobile accident victims. The lap-type seat belt itself, however, has become a source of serious intra-abdominal injuries. Rupture of the spleen (3, 7), a pregnant uterus (8) pancreas (4), duodenum (4, 11), jejunum (1, 7, 9, 10), ileum (5, 7, 11), cecum (5), or the sigmoid colon (2, 7, 10), laceration of the mesentery (5, 7, 9, 11), avulsion of the omentum (11), contusion of the kidney and bladder (3), and obstruction of the ileum due to adhesions (6) have been reported in victims of automobile accidents wearing the lap-type seat belt. This case illustrates a previously unreported injury to the abdominal aorta. Case Report A 24-year-old Caucasian male was driving a pickup truck on Aug. 7, 1967. The truck turned over seven times from side to side and from left to right down a 70-foot cliff and landed on all four wheels. The patient was wearing a lap-type seat belt loosely around his abdomen. He was not unconscious and removed himself from the vehicle. Six hours elapsed before he was taken to a medical facility where he was found to be responsive to deep pain stimuli only. No blood pressure was obtainable. His pulse was 140, and he was pale and cyanotic. He sustained a third-degree burn around the lower abdomen and flanks, presumably due to the seat belt. Peristalsis was absent, and the abdomen was rigid. Abdominal tap revealed gross blood which did not clot. X-ray examination revealed a wedge fracture of L-l (Fig. 2). At surgery, free blood was seen in the peritoneal cavity, apparently coming from a tear of the mesenteric arteries to the small bowel. There was a laceration of the inferior vena cava. The hepatic flexure and sigmoid colon were both devitalized and crushed, and a portion of the small bowel was also lacerated and devitalized. The patient recovered well from his surgery, but on Sept. 1 a colocutaneous fistula developed in the left lower quadrant. This was closed on Nov. 30, and the patient was discharged on Dec. 14. On Jan. 9, 1968, crampy pain developed in the right lower anterior chest wall, right upper quadrant, and right flank. This was associated with nausea and vomiting. On Jan. 11 an abdominal examination revealed a scaphoid abdominal wall without distension, a well healed right subcostal scar, a well healed scar in the left midquadrant which extended from the umbilicus to the left flank, and a well healed stab wound in the left lower quadrant. Bowel sounds were hyperactive with rushes and borborygmus. The liver edge was palpable; no guarding, rebound, or muscle spasm was present. X-ray examination revealed a mechanical obstruction of the small bowel. On treatment with a Miller-Abbott tube for small bowel obstruction, the patient did well, passed gas per rectum, and the tube was removed on Jan. 24. On Feb. 29, the patient began vomiting but had no abdominal pain.