The Seat Belt Syndrome

Blumenberg, Robert M.

doi:10.1097/00000658-196704000-00023

Cited by 27 publications

(8 citation statements)

References 4 publications

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“…Avulsions and tears of the colon mesentery occur at points of fixation of otherwise mobile viscera and mesenteries, whereas explosive visceral perforations are generally at a point where the structure overlies immobile bony framework [ 7 , 14 ]. It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury [ 15 ]. Small mesenteric vessels are torn by direct force, but mesenteric avulsion and hematoma formation with subsequent ischemia are associated with a torsion (turning with force) injury [ 7 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of mesenteric injuries tends to be delayed, as mesenteric injury from blunt abdominal trauma is uncommon and can be difficult to diagnose [ 7 , 15 ]. Examinations might detect a rigid abdomen, generalized tenderness (guarding or rebound), and bowel sounds ranging from quiet to absent.…”

Section: Discussionmentioning

confidence: 99%

“…This is known because of the type of injury sustained (a.k.a. The Seatbelt Syndrome), where violence applied by an external force to an entrapped hollow viscus (the colon) at a fixed point (the seatbelt), results in mesenteric tears [ 7 ]. However, instead…”

Section: Case Reportmentioning

confidence: 99%

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Mesenteric Tear Can Be Caused by Abdominal Counter-Pressure Applied During Colonoscopy

Shacket¹,

Guthrie

2021

Am J Case Rep

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Patient: Female, 72-year-old Final Diagnosis: Mesenteric hematoma Symptoms: Abdominal pain • bloating • nausea • vomiting Medication: — Clinical Procedure: Screening colonoscopy • followed by open laparoscopy with the evacuation of a hematoma Specialty: Gastroenterology and Hepatology • Surgery Objective: Diagnostic/therapeutic accidents Background: We report the case of a patient undergoing a colonoscopy during which pressure applied on the abdomen by a nurse assisting in the procedure caused an extraluminal mesenteric tear. Mesenteric tears can be life-threating and need to be managed appropriately. This is the first case reported in the literature describing abdominal counter-pressure applied in the endoscopic procedure room as the cause of traumatic bowel injury. Case Report: A 72-year-old woman presented for a screening colonoscopy. Advancement of the colonoscope became so difficult that the procedure was temporarily aborted. To reduce looping of the colonoscope, the nurse assistant applied a forceful two-handed counter-pressure maneuver upon the abdomen to help the endoscopist advance the colonoscope to the cecum. After the procedure, the patient complained of abdominal pain and nausea. A CT scan of the abdomen showed a hematoma abutting the anterior abdominal wall. Unfortunately, laparoscopic surgery was hastily recommended over conservative medical management. Approximately 500 mL of old blood was evacuated. The patient survived postoperative complications, including pneumonia, respiratory failure, and sepsis. Conclusions: Mesenteric tears are a rare but potentially life-threatening complication of colonoscopy. Post-colonoscopy patients with severe nausea, abdominal pain and/or distention, who fail to demonstrate free air in the abdomen, should have a CT scan with i.v. contrast to assess their condition. Hemodynamically stable patients should be managed with serial vitals and bedside observations, laboratory tests, imaging studies, fluid replenishment, and medication, to avoid unnecessary high-risk surgery. Abdominal counter-pressure applied safely during colonoscopy can reduce the risk of injury inherent in the procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

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Mesenteric Tear Can Be Caused by Abdominal Counter-Pressure Applied During Colonoscopy

Shacket¹,

Guthrie

2021

Am J Case Rep

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“…Sube arid others (1967) described a delay in presentation of from a to 13 days in 4 of the patients whom they reviewed. Blumenberg's (1967) patient with traumatic ischaemia of the sigmoid colon presented 72 hours after injury. Towne and Coe (1971) reported a delay in the presentation of 3 of their 4 patients.…”

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confidence: 99%

Seat-belt injuries of the left colon

Shennan

1973

Journal of British Surgery

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SUMMARYT w o patients with a particular type of isolated injury to the left colon produced by the lapstrap of a seat belt are described. T h e literature on this subject is reviewed and the features and management of these injuries are discussed, with particular reference to the delay i n presentation often seen in such patients and to the frequent association with ischaemic damage which makes proximal colostomy advisable where primary repair is undertaken.OF 4 patients presenting at a major accident centre with closed injuries of the left colon, there were 2 in whom a seat belt appeared to have been responsible for the injury. These 2 patients are reported a n d the features of seat-belt injuries of the colon are described together with a review of the literature and a discussion of the management of this type of injury. CASE REPORTSCase I.-A 42-year-old lorry driver was admitted to the Accident Centre at Walton Hospital, Liverpool, on 18 March, 1970. He had been driving a car which had been in collision with another car 14 hours earlier. He had been wearing a lapstrap and diagonal belt type of seat belt.He had sustained a head injury and after regaining consciousness he had noticed some discomfort in his left lower abdomen which he had attributed to the tightening of his seat belt at the time of impact. This sensation had rapidly passed off and he had felt well enough to return home without attending hospital.Twelve hours later (2 hours prior to admission) the discomfort had returned and had slowly increased in severity, being latterly aggravated by movement and by coughing. He had therefore attended the Accident Centre.He stated that he had passed both flatus and faeces per rectum since the accident and at the initial examination the only positive finding was of localized moderate tenderness without guarding in the left lower quadrant of his abdomen. Straight radiographs of his abdomen showed no abnormality. It was felt that he had suffered a 49 contusion of his abdominal wall from his seat belt but nevertheless he was detained in hospital under observation.His condition did not change for 6 hours but then he developed a pyrexia associated with a tachycardia, and further examination disclosed a slight but definite increase in his still-localized abdominal tenderness with, more significantly, the appearance of associated guarding.With this evidence of intraperitoneal injury laparotomy was undertaken, being commenced 94 hours after admission and 236 hours after the injury.At operation, apart from an area of minor contusion of the lower ileum, the only finding was that the lower descending colon was gangrenous over a length of 7 cm. The colon was intact although perforation was imminent, and the damaged segment was exteriorized by the method of Paul and Mikulicz through a separate incision in the left lower quadrant, and resected at skin level after closure of the main wound.The postoperative course was uneventful and the colostomy was closed on the twentieth day. The patient was allowed home 13 days later and wh...

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Epidemiology of Child Motor Vehicle Crash Injuries and Fatalities

Arbogast

Durbin

2012

Pediatric Injury Biomechanics

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The Seat Belt Syndrome

Cited by 27 publications

References 4 publications

Mesenteric Tear Can Be Caused by Abdominal Counter-Pressure Applied During Colonoscopy

Mesenteric Tear Can Be Caused by Abdominal Counter-Pressure Applied During Colonoscopy

Seat-belt injuries of the left colon

Epidemiology of Child Motor Vehicle Crash Injuries and Fatalities

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