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Case Reports
. 2018 Aug 26:2018:4251408.
doi: 10.1155/2018/4251408. eCollection 2018.

Positive Seatbelt Sign with Avulsed Leiomyoma following Motor Vehicle Accident Leading to Hemoperitoneum

Martin A C Manoukian  1 , Amode R Tembhekar  1 , Sarah E Medeiros  2
Affiliations
Case Reports

Positive Seatbelt Sign with Avulsed Leiomyoma following Motor Vehicle Accident Leading to Hemoperitoneum

Martin A C Manoukian et al. Case Rep Emerg Med. .

Abstract

A positive seatbelt sign following a motor vehicle accident is associated with an increased risk of intra-abdominal injury and hemoperitoneum. Injury to the uterus in reproductive-age women can also occur. In this report, we describe a 29-year-old nulligravida female who presented to the emergency room following a motor vehicle accident at freeway speeds. A positive seatbelt sign was noted, and a focused assessment with sonography for trauma revealed hemoperitoneum with an incidental finding of uterine leiomyomata. Upon exploratory laparotomy, a free-floating intraperitoneal mass was identified as an avulsed uterine leiomyoma. A uterine laceration containing a subserosal leiomyoma was also identified. The gynecological team was consulted, and a myomectomy of the subserosal leiomyoma followed by a closure of the uterine laceration was performed. The patient was transfused with a total of three units of packed red blood cells and two units of fresh frozen plasma. The postoperative course was without major complication. A positive seatbelt sign and hemoperitoneum in a reproductive-age woman with leiomyomata should increase the clinical suspicion for uterine injury and decrease the threshold for obtaining a gynecological consultation.

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Figures

Figure 1
Figure 1
Free fluid noted in right upper quadrant on FAST scan (a). Incidental leiomyomata uteri noted as seen in the sagittal (b) and transverse (c) planes.
Figure 2
Figure 2
Two images of the 6 cm x 8 cm avulsed uterine leiomyoma recovered from the patient during laparotomy.
See this image and copyright information in PMC

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