We present a case of late gastric perforation caused by retained T-fasteners after removal of a percutaneous endoscopic gastrostomy tube. We emphasize that timely removal of these fasteners is important in preventing this complication.

Seat-belt syndrome is defined as the presence of a seat-belt sign predominantly involving thoracolumbar vertebral fractures and intra-abdominal organ injury following the use of a seat belt during a traffic collision. Isolated sigmoid colon perforation occurring as part of seat-belt syndrome is rare. We report a 34-year-old patient who presented seat-belt sign after his car collided with a guardrail. The patient was initially haemodynamically stable and complained lower abdomen pain. Serial clinical examination with abdominal computed tomography (CT) scans illustrated sigmoid colon with ischaemic change without perforation. Exploratory laparotomy was performed and isolated sigmoid colon perforation was diagnosed. Therefore, in cases of persistent abdominal pain or tenderness despite an initially negative CT scan, repeated examinations of the abdomen with following abdominal CT are recommended because of the high risk of seat-belt sign and the possibility that the peritoneal symptoms can be hidden, such as in the retroperitoneal duodenum or sigmoid colon. Thus, we recommend using repeat abdominal CT as an adjunct to secondary survey for clarifying the haemodynamic status of patients with seat-belt trauma. (Hong Kong j.emerg.med. 2017;24: 100-103)