title: Massive rectal bleeding distant from a blunt car trauma.
abstract: 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.
authors.affiliation: Departments of General and Digestive Surgery, Louis-Mourier University-Hospital, AP-HP, Paris Diderot (Paris-7) University, 178 rue des Renouillers, Colombes cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Gruden
authors.forename: E
authors.initials: E
authors.lastname: Ragot
authors.forename: R
authors.initials: R
authors.lastname: Arienzo
authors.forename: A
authors.initials: A
authors.lastname: Revaux
authors.forename: M
authors.initials: M
authors.lastname: Magri
authors.forename: M
authors.initials: M
authors.lastname: Grossin
authors.forename: C
authors.initials: C
authors.lastname: Leroy
authors.forename: S
authors.initials: S
authors.lastname: Msika
authors.forename: R
authors.initials: R
authors.lastname: Kianmanesh
mesh_terms: 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*