Seat Belt Injury Diagnosed as Perforation of the 4th Portion of the Duodenum Two Days after a Traffic Accident: A Case Report

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INTRODUCTION: Car seat belts are safety devices that protect passengers during collisions in traffic accidents. However, seat belts can cause abdominal injuries during collisions. Many cases of injury to various intraperitoneal organs caused by seat belts have been reported, but reports of duodenal injury are relatively rare. In addition, diagnosing duodenal injury due to blunt trauma is not easy, and it is not uncommon for cases to be diagnosed long after injury. Here, we report a case in which a patient was diagnosed with perforation of the 4th portion of the duodenum 2 days after injury in a traffic accident. CASE PRESENTATION: A 67-year-old woman was transported to our hospital after driving a car that collided with a wall. A seat belt mark was observed on her abdomen. A CT scan performed on the day of the injury confirmed a small poorly enhanced area in the duodenum, but no obvious signs of intestinal perforation were found. CT scan also revealed abdominal aortic dissection, a right clavicle fracture, and bilateral rib fractures. Two days later, a CT scan revealed expansion of the poorly enhanced area of the intestinal wall and a small amount of free air in the 4th portion of the duodenum. As duodenal perforation was suspected, emergency surgery was performed. Laparoscopic surgery was performed, and a quarter-circumferential perforation was found in the 4th portion of the duodenum. The perforation was closed with barbed sutures. The patient began oral intake of fluids on POD 7. The abdominal aortic dissection improved with conservative treatment, and the patient was discharged on POD 60 without any postoperative complications. CONCLUSIONS: We report a case of duodenal injury and abdominal aortic dissection caused by a seat belt during a collision. The reason may be that the seat belt moved toward the upper abdomen during the collision, causing compression of the abdominal organs between the seat belt and the spine. Considering the possibility of delayed duodenal perforation, it is important to perform a CT scan again and select an appropriate treatment according to the situation.

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