[Abdominal lesions associated to safety belt mark].

INTRODUCTION

Motor vehicle crashes cause 28% of morbidity and mortality in children. A proper medical evaluation of the polytraumatized patient is essential to reduce these numbers. The aim of our study is to correlate clinical and radiological signs in patients with seat belt mark, to establish an early diagnosis of internal injuries.

MATERIALS AND METHODS

From 1998 to 2007 we treated 8 cases of polytraumatized patients (5 boys and 3 girls) with abdominal bruises (seat belt mark) after suffering a traffic accident. The mean age was 8.37 years (range: 4-11). 100% of the patients suffered a frontal collision of their vehicle. In 2 cases the position of the lap belt was inadequate. The trauma team made the initial attention of all patients in the Emergency room, with a complete physical examination and they requested: abdominal X-ray, ultrasound and computed tomography (CT-scan).

RESULTS

The main clinical signs found in our patients were: one case of hemodynamic instability, hypovolemic shock and abdominal distension; 2 cases of diffuse abdominal pain and signs of peritoneal irritation; 4 cases of non-specific diffuse abdominal pain and one patient in coma with Glasgow 8. The radiological signs found were: abdominal free fluid (detected in 100% of the CT-scan and only in 75% of ultrasound studies), thickening and enhancement of small bowel (62.5%), mesenteric infiltration (87.5 %) and pneumoperitoneum (37.5%). The surgical findings were: seven cases (87.5%) of an intestinal bursting perforation and one case of vascular injury of the medium colic vein. The diagnosis of intestinal perforation was late established in five patients, and they underwent treatment between 5 and 19 days after the accident.

CONCLUSIONS

All our patients (100%) with a seat belt mark presented abdominal injuries. The treatment is frequently delayed due to the difficulty in establishing the diagnosis. The finding of cutaneous ecchymosis caused by the lap belt must be a warning sign to suspect abdominal injuries. The CT scan is the most effective imaging technique to study patients with seat belt mark.