Abdominal aortic injury associated with “seat belt syndrome”

Abstract

Flexion±distraction spinal injuries and intraabdominal visceral injuries have a well-recognized association with the use of passive restraints during motor vehicle collisions. Abdominal aortic injury due to blunt trauma is rare. However, there is a reported association of this injury with seat belt use. We report a case of a restrained passenger in a motor vehicle collision who sustained this triad of injuries, with the abdominal aortic injury not initially suspected.Key words seat belts ± spinal fractures ± aortic rupture ± abdominal injuries ± aorta ± aorta/abdominal Case reportA 21 year-old restrained male passenger was involved in a highspeed motor vehicle collision with a tree. He was alert but complained of upper abdominal and low back pain. Physical examination revealed shoulder and lap belt abrasions and ecchymosis across the chest and abdomen. Vital signs were stable, and peripheral pulses were reportedly normal. The abdomen was diffusely tender, with tense abdominal muscles. Neurologic examination was normal. Diagnostic peritoneal lavage (DPL) was grossly negative, but microscopic analysis revealed 155,000 red blood cells/ml and 700 white cells/ml.Conventional radiographs of the lumbar spine ( Fig. 1) obtained shortly after arrival showed a flexion±distraction injury at L1±L2.Because of the presence of abdominal symptoms and signs, a positive DPL, and a flexion±distraction spinal injury, an abdominal CT was obtained (Fig. 2). This showed marked focal small bowel dilatation and wall thickening in the left upper quadrant and midabdomen. There was an irregular circumferential filling defect in the infrarenal abdominal aorta and a large central retroperitoneal hematoma. Angiography (Fig. 3) obtained immediately afterwards confirmed the aortic injury seen on CT, showing circumferential dissection and pseudoaneurysm of the abdominal aorta at the level of the inferior mesenteric artery, midway between the renal arteries and the iliac bifurcation, with proximal and distal stenoses.Exploratory laparotomy was then performed and revealed perforation of the proximal jejunum with mesenteric hematoma and serosal injuries of the stomach, proximal jejunum, and distal transverse colon, as well as a slowly expanding central retroperitoneal hematoma. These injuries were repaired. No duodenal or pancreatic injury was found. Open repair of the pseudoaneurysm was contraindicated because of peritoneal contamination from bowel injury. Therefore, while the patient was in the operating room, a Wallstent was placed across the aortic defect by percutaneous endovascular technique. Because of continued filling of the pseudoaneurysm, an endovascular stent graft was placed 24 h later, with no further evidence of filling. The patient subsequently underwent open reduction and internal fixation of his spinal injury, and was later discharged in stable condition. DiscussionAlthough the value of passive restraints in preventing serious and life threatening injuries in vehicular collisions is unquestioned, injuries associated with their use ...

Motor Vehicle Collisions and Their Demographics: A 5‐Year Retrospective Study of the Hamilton‐Wentworth Niagara Region*

“…Fatalities were primarily drivers and frequently pedestrians and front seat passengers. As supported in the literature (1,14,15,17–23,26), the injury patterns commonly afflict drivers, pedestrians, and front seat passengers. Drivers were also commonly 20–29 and 30–49 years.…”

“…Motor vehicle collisions with resultant fatalities can involve numerous contributing factors. These fatalities have been reported in the literature often in the context of particular areas of interest such as gender, age (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13), site of injury (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26), and toxicology (8,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Results are limited to certain populations and various study criteria limiting generalization.…”

Seat Belt Injuries of the Abdominal Aorta in Adults—Case Report and Literature Review

“…dead Vernhet 31 Aortic dissection involving bilateral CIAs Below IMA Fasciotomies Delayed (4 months) aortic stenting (Palmaz P308, 8-12 Â 30 mm) Shweiki 32 Aortic intimal and media injury Below IMA Aortic TEA Perry 33 Circumferential aortic dissection þ pseudoaneurysm Below RA Aortic stenting (18 Â 40 mm Wallstent) þ endograft (tubular AneuRx 20 Â 37 mm) Fontaine 34 Circumferential aortic dissection þ pseudoaneurysm Below RA Aortic stenting (18 Â 40 mm Wallstent) þ endograft (tubular AneuRx 20 Â 37 mm) Inaba 35 Aortic intimal flap with dissection Below RA Intimal flap resection, aorto-biliac and bifemoral TEA Voellinger 36 Aortic contained transection between 2 intimal flaps þ pseudoaneurysm…”

“…45,46 Sporadic reports on successful EVT for the acute treatment of seat belt abdominal aortic injuries have been published since the end of the 1990s. 29,33,36,37,40 Emergent EVT represents a practical solution in case of abdominal contamination and may be particularly beneficial to patients requiring either ''damage control surgery'' or ''nonoperative management'' of associated lesions. Emergent EVT, however, can be performed in selected high-volume centers with rapid access to emergent intraoperative fluoroscopy and a wide choice of readily available consumables.…”

“…23 Atheroma and superadded thrombus Below RA Fasciotomies þ PT arteries embolectomy. (12 days) below knee bilateral amputation Warrian 24 Aortic occlusion due to intimal transection and media fragmentation þ IMA occlusion L3-L4 DeBakey woven Dacron 12 mm aortic graft interposition Crepps 25 Intima-media transection Below RA ePTFE 16 mm aortic sleeve graft replacement and IMA reimplant Reisman 26 Intimal transection Below RA Bilateral distal thrombectomy and Goretex 14 mm aortic graft interposition Randhawa 14 Aortic occlusion due to circumferential intimal and medial fracture folded flap Below IMA Goretex 20 mm aortic graft interposition Aortic occlusion due to circumferential intimal fracture folded flap Below RA Dacron 14 mm aortic graft interposition and IMA ligation Siriwardena 27 Distal right popliteal occlusion due to atheromatous embolization from aorto-iliac atherosclerosis Below RA Fasciotomies þ bilateral infra-popliteal selective embolectomy Braithwaite 28 Circumferential intimal and medial disruption þ IMA avulsion Below RA Goretex 16 mm aortic graft interposition and IMA reimplant Michaels 29 Aortic 32 Aortic intimal and media injury Below IMA Aortic TEA Perry 33 Circumferential aortic dissection þ pseudoaneurysm Below RA Aortic stenting (18 Â 40 mm Wallstent) þ endograft (tubular AneuRx 20 Â 37 mm) Fontaine 34 Circumferential aortic dissection þ pseudoaneurysm Below RA Aortic stenting (18 Â 40 mm Wallstent) þ endograft (tubular AneuRx 20 Â 37 mm) Inaba 35 Aortic intimal flap with dissection Below RA Intimal flap resection, aorto-biliac and bifemoral TEA Voellinger 36 Aortic contained transection between 2 intimal flaps þ pseudoaneurysm Below IMA Stent-graft placement (55 Â 14 mm, AneuRx)…”