Massive rectal bleeding distant from a blunt car trauma.
Mesenteric trauma is one of the possible injuries caused by the use of seat belts in case of motor vehicle crash. We report here a rare case of rectal bleeding by rupture of a mesosigmoid haematoma. An emergent laparotomy revealed a mesosigmoid haematoma with a centimetric rectal perforation. The wearing of safety belts added some specific blunt abdominal trauma, which directly depends on lap-and-sash belts. Mesenteric injuries are found out up to 5% of blunt abdominal traumas. "Seat belt mark" leads the surgical team to strongly suspect an intra-abdominal trauma. When "seat belt mark" sign is found, in patients with mild to severe blunt car injuries, CT-scan has to be realised to eliminate intra-abdominal complications, including mesenteric and mesosigmoid ones. In case of proved mesenteric haematoma associated to intestinal bleeding, a surgical treatment must be considered as first choice. Conservative approach remains possible in stable patients but surgical exploration remains necessary in unstable patients with active bleeding.
Gruden
E
E
Departments of General and Digestive Surgery, Louis-Mourier University-Hospital, AP-HP, Paris Diderot (Paris-7) University, 178 rue des Renouillers, Colombes cedex, France.
Ragot
E
E
Arienzo
R
R
Revaux
A
A
Magri
M
M
Grossin
M
M
Leroy
C
C
Msika
S
S
Kianmanesh
R
R
D000063:Accidents, Traffic; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006406:Hematoma / Q000150:complications* / Q000601:surgery; D006801:Humans; D007813:Laparotomy; D008297:Male; D008646:Mesocolon / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D012007:Rectum / Q000293:injuries* / Q000601:surgery; D012421:Rupture / Q000150:complications / Q000601:surgery; D012622:Seat Belts / Q000009:adverse effects*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications*