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

Abstract

Blunt abdominal trauma with major vascular involvement is found to be rare. Although few series have been reported in the literature, the true incidence of blunt abdominal aortic injury is unknown. Different modalities of blunt trauma may occur among civilians with steering wheel and seat belt injury secondary to motor vehicle accident the most frequent. Mechanical forces produce variable patterns of injury; therefore, the onset of signs and symptoms can be different. Dissection and thrombosis of the abdominal aorta have been frequently described among seat-belted adult patients with major vascular involvement. The associated abdominal viscus and/or vertebral lesions must always be taken into account. Prompt diagnosis allows adequate surgical treatment. We present the case of a 66-year-old woman, restrained front passenger involved in a motor vehicle collision, who had small bowel transection, vertebral fractures, and aortic partial occlusion below inferior mesenteric artery with bilateral iliac artery involvement. Along with the case reported, the purpose of this study is to highlight and compare features and management of the previous cases described in the English literature.

Aortic Seat Belt Syndrome, A Rare Abdominal Aortic Injury Managed with Endovascular Treatment: A Case Report and Literature Review

“…Fortunately, such injuries are rare but the true incidence is unknown [3]. Freni, et al estimated the incidence of blunt abdominal aortic injury to range between 0.01% and 0.07% [3].…”

“…Seat belt aorta is a potentially fatal, rare injury that typically involves acute aortic intimal tear with, variably, consequent dissection caused by direct compression of the aorta against the vertebrae [2][3]. Other patterns of injury include partial or complete aortic occlusion, disruption of the aortic intima and media with the subsequent pseudoaneurysm development and aortic rupture with active hemorrhage [3].…”

Seat belt syndrome, a new pattern of injury in developing countries. Case report and review of literature

“…Seat belt syndrome is a result of the pressure that the belt causes along its course. Mechanical forces from seat belt cause different types of injuries in a car accident, so the types of signs and symptoms may differ (4).…”

Patients Who Underwent Surgery for Blunt Abdominal Aortic Injury Have Higher Risk of Perioperative Mortality, Pneumonia, and Longer Hospital Length of Stay

“…11 Consideration of overall clinical status, injury severity, and presentation are of great importance when determining a course of treatment. 10 While minor contusions or intimal disruptions may be managed conservatively, 11 open repair has been the treatment of choice for more severe injury management in the past. 9 Most recently endovascular procedures have become available as an option for treatment.…”

“…5 The presentation of injury varies and may include intimal disruption with or without thrombosis, intramural hematoma, aortic pseudoaneurysm, and transection with exsanguinating hemorrhage. 9 Clinically, the most frequent presentation includes shock, abdominal pain, 10 acute arterial insufficiency, neuromuscular deficits, and abdominal wall defect. 9 Treatment options for BAAI are dependent on the nature of the injury.…”