Transection of the appendix and omentum following a seat belt injury; case report and literature review

Abstract

IntroductionAppendiceal injuries following a blunt abdominal trauma are rare. Upon literature review, several cases have been reported to develop appendicitis following blunt abdominal trauma, but total transection of the appendix is extremely rare.Case presentationOur case involves a 24-year-old male restrained driver who was involved in a motor vehicle accident. He had bruising corresponding to the pattern of the seatbelt, the ‘seatbelt sign’, on admission. On his second day of admission, he was found to have a rigid abdomen. On exploratory laparotomy, the patient had a completely transected appendix with a 10 × 10 cm piece of transected omentum lying in the pelvic cavity.DiscussionLiterature suggests that seat belts may play a role in the mechanism of injury leading to transection.ConclusionSince the introduction of seatbelt in the 1970s, fatalities from road traffic accidents have fallen by up to 60%. However, the seat belt itself is associated with a unique injury profile, including intestinal tears, perforations, and transections, collectively termed “the seatbelt syndrome”. Seat belt syndrome injuries may sometimes have a delayed presentation, thus repeated abdominal examination is recommended even if the patient is initially stable. Appendiceal transection is rare but may occur. A thorough inspection of the abdominal soft tissue to look for accompanying injuries is important if case an exploratory laparotomy is warranted.

Floating appendix: post-traumatic amputation of the appendix as sequela or complication?: a case report

“…Appendiceal transection is seen in cases of seat-belt injury, where the compression and deceleration forces cause an increase in intraluminal pressure [ 7 ]. In children, handle-bar injuries are also a leading cause of appendiceal transection [ 5 , 8 ].…”

Amputación Traumática del Apéndice Cecal como Causa de Abdomen Agudo. Reporte de un Caso

“…paciente de 23 años con transección apendicular del tercio distal, manejado con apendicectomía y dado de alta con única complicación infección de sitio quirúrgico a los 15 días. (Seung G. J., 2016) o AlJaberi que manejo a un paciente de 24 años con transección del tercio distal del apéndice y parcial de omento mayor con apendicectomía y retiro de cavidad de omento y que cursó con adecuada evolución (AlJaberi, Salameh, Almarzooqi, Emar, & Salhab, 2018). Nuestro manejo fue con apendicectomía y resección de íleon por la perforación y lesión en su mesenterio que comprometía la irrigación de este segmento y se reconstruyó con una anastomosis, la cual se consideró una buena opción en ausencia de compromiso hemodinámico, adecuada resucitación por todos los servicios involucrados y ausencia de edema de asa asociado a la reperfusión (Schnüriger B, 2011) la cual curso sin complicaciones en el seguimiento.…”