Transection of Rectus Abdominis Following a Seatbelt Injury: A Case Report

Case Report

Austin J Surg. 2023; 10(3): 1305.

Transection of Rectus Abdominis Following a Seatbelt Injury: A Case Report

Dabbagh M*; Maazouz A; Hablaj H; Sabur M; EL Azzaoui I; Lamghari M; Bensal; Najih M; EL Kaoui H; Moujahid M; Bouchentouf M; Bounaim A

Department of General Surgery, Mohammed V Military Hospital, Rabat, Morocco

*Corresponding author: Dabbagh M Department of General Surgery, Mohammed V Military Hospital, Rabat, Morocco. Tel: 212668699621 Email: mahmoud.dabbagh@um5r.ac.ma

Received: May 12, 2023 Accepted: June 02, 2023 Published: June 09, 2023

Abstract

Background: With the introduction of the use of seatbelts in cars, mortality following motor vehicle collisions has decreased significantly. They have, however, introduced a set of injuries comprising abdominal wall bruising and intra-abdominal injuries. Injuries may consist of traumatic abdominal wall disruption. Closed rupture of rectus abdominis following seatbelt related trauma is rare.

Case Presentation: We present the case of a 68 years old male who presented with a closed rupture of the rectus abdominis without other intra abdominals injuries, following a high velocity road traffic accident. He was brought in with an acute abdomen and a seatbelt sign upon which the decision was made to perform emergency laparotomy. After further management, the patient was discharged with no further complaints.

Conclusion: Our case highlights the need for suspicion, investigation and subsequent surgical management of intra-abdominal injury following identification of this rare consequence of seat belt trauma.

Keywords: Seat belt; Abdominal injuries; Rectus abdominis; Hemoperitoneum

Introduction

When the seat belts were introduced in cars, morbidity and mortality rates following motor vehicle crashes dropped considerably [1].

Most blunt injuries are due to falls and road traffic accidents [2]. A traumatic abdominal wall is rare, occurring after a high velocity impact of a blunt object on the abdominal wall. In motor vehicle collisions, the wearing of a seatbelt has reduced mortality by 45% and the risk of serious injury by 50% [3]. The likelihood of intra abdominal injury in patients with a seatbelt sign is increased up to 4-20 percent [4,5]. However it is associated with certain abdominal injuries. Solid viscus organs are especially afflicted in patients with a mal-positioned lap belt [6].

Here, we report the case of an aged male with a massive hemoperitoneum caused by complete transection of the rectus abdominis muscle, we briefly review the literature.

Case Presentation

A 68-year-old male sustained injuries as a driver, wearing a three-point seat belt, in a car involved in a head-on collision with a traffic light pole.

On admission, primary survey revealed a combative hemodynamically unstable patient requiring sedation and intubation, and tachycardia of 115bpm, his Blood Pressure (BP) of 06/30 mmHg which responded to intravenous fluid replacement. Abdominal examination revealed a soft abdomen, diffusely tender, with bruising to flanks and in the distribution of the seatbelt, from left hypochondrium to right inguinal region and a left lower abdomen contusion.

A Focused Abdominal Sonography for Trauma (FAST) showed free fluid around liver, spleen, mesenteries and the pelvic cavity.

Since at that point the patient was always hemodynamically unstable, he underwent an emergency laparotomy through the midline who revealed a massive hemoperitoneum and complete transection of the right left abdominis muscle (Figure 1 and 2) exactly beneath the seat belt sign and devascularization of the skin under the areas of seat-belt related bruising. The attached peritoneum was also ruptured. Along the small intestines some bleeding from small mesenterial tears was suture-ligated. Approximately 2 liters of blood were evacuated from the abdominal cavity. Hemostasis was achieved by applying suture-ligations proximal and distal to the cut ends of the muscle, the abdominal wall muscles were repaired in a layer-by-layer manner using interrupted monofilament absorbable sutures. No other source of hemorrhage was identified besides the transected muscle. After leaving a drain in this area the abdomen was closed primarily and the patient was transferred to the intensive care unit.

Citation: Dabbagh M, Maazouz A, Hablaj H, Sabur M, EL Azzaoui I, et al. Transection of Rectus Abdominis Following a Seatbelt Injury: A Case Report. Austin J Surg. 2023; 10(3): 1305.