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Case Reports
. 2020:72:197-201.
doi: 10.1016/j.ijscr.2020.05.008. Epub 2020 May 19.

The importance of wearing a seatbelt correctly - A case report of blunt trauma causing complete shearing transection of the gastroduodenal junction

Matheesha Herath  1 , Peter Bautz  2 , Dominic Parker  2 , Christopher Dobbins  2
Affiliations
Case Reports

The importance of wearing a seatbelt correctly - A case report of blunt trauma causing complete shearing transection of the gastroduodenal junction

Matheesha Herath et al. Int J Surg Case Rep. 2020.

Abstract

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.

Keywords: Emergency surgery; Road traffic accident; Seatbelt; Trauma; Upper gastrointestinal injury.

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Figures

Image 1
Image 1
Axial CT demonstrating a distended stomach and free intra-abdominal fluid.
Image 2
Image 2
Axial CT demonstrating free gastric content in the peritoneal cavity.
Image 3
Image 3
Axial CT showing free fluid around the liver.
Image 4
Image 4
Sagittal CT demonstrating pyloric and duodenal discontinuity with small volume free air just beyond the pylorus.
Image 5
Image 5
Coronal CT demonstrating splenic laceration with surrounding free fluid.
See this image and copyright information in PMC

References

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