Herath M, Bautz P, Parker D, Dobbins C. The importance of wearing a seatbelt correctly - A case report of blunt trauma causing complete shearing transection of the gastroduodenal junction.
Int J Surg Case Rep 2020;
72:197-201. [PMID:
32544828 PMCID:
PMC7298554 DOI:
10.1016/j.ijscr.2020.05.008]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/02/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022] Open
Abstract
Seat belt related injuries can cause significant morbidity and mortality in road traffic accidents.
We present a case where an improperly worn seatbelt caused traumatic shearing transection of the gastroduodenal junction.
A systematic multidisciplinary assessment approach enabled all injuries to be identified early.
The patient underwent damage control exploratory laparotomy then delayed reconstruction of the alimentary tract.
Introduction
Global mortality as a result of road traffic accidents (RTA) has reduced significantly since mandatory implementation of seatbelts. Whilst seatbelt related injury, or “seatbelt syndrome,” is a recognised phenomenon, unrestrained passengers have considerably worse survival outcomes. Improper positioning of seatbelts, as is discussed in the following case, can cause extensive injury.
Presentation of case
Our patient is a 35-year-old female who was a restrained front seat passenger in a car vs. tree collision at 80 km/h. Her seat belt was worn with the shoulder strap under her left axilla. She sustained multiple injuries including complete transection of the gastroduodenal junction. In addition to this she had splenic, liver, transverse colonic, left lower rib and humeral injury. She underwent damage control laparotomy with splenectomy; re-look with gastrojejunostomy and transverse colonic resection with defunctioning ileostomy. She made a good recovery and was discharged after a 4 week admission.
Discussion
Improperly worn seatbelts redistribute decelerative forces to sensitive regions. A multidisciplinary approach is required to effectively manage complex multi-system trauma. In trauma the simplest reconstructive measures can be the most effective and minimise risk of further complications for the patient.
Conclusion
Improperly worn seatbelts pose a significant risk to patients. A traumatic complete gastroduodenal transection can be effectively reconstructed with gastrojejunostomy anastomosis.
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