Chest and Abdominal Injuries Caused By Seat Belt Wearing

J. L. Greingor, MD; S. Lazarus, MD

Disclosures

South Med J. 2006;99(4):534-535. 

In This Article

Case Report

A 22-year-old man was the front passenger in a car involved in a head-on collision. Upon arrival at the emergency department, he was alert, but complained of severe middle thoracic pain, which required IV opiate administration. His heart rate was 100/min, blood pressure 120/75 mm Hg and Glasgow coma scale was 15. Respiratory rate was 22 breaths/min and oxygen saturation was 98 on air room. The physical examination revealed a diagonal ecchymosis across the chest and a transverse abdominal abrasion. The intensity of the pain resulting from the sternal fracture made abdominal examination difficult to perform. The electrocardiograms at admission and on the subsequent days revealed an incomplete right bundle branch block. The initial chemistry was unremarkable. The cardiac markers were not consistent with myocardial contusion. Chest x-ray showed clear lung fields. Lateral radiography of the sternum revealed a transverse fracture of the body with displacement. The patient was admitted to the intensive care unit for close observation. Positive peritoneal signs became evident on the second day, and abdominal palpation revealed an increase in tenderness. A CT scan was performed and a bowel injury was diagnosed. The patient underwent a laparotomy which revealed a tear of the jejunum and mesenteric contusion. The postoperative period was unremarkable.

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