title: Delayed diagnosis of blunt carotid trauma in a seat belt syndrome with associated abdominal wall injury A case report.
abstract: The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal trauma because, carotid artery injury consequent to blunt trauma is rare, affecting less than 1% of patients as reported in literature. A 45-years-old female, involved in a traffic accident, arrived to Emergency Room hemodynamically stable, with a Glasgow Coma Scale of 15, complaining abdominal pain, without any neurological signs. She underwent Computed Tomography (CT) scan that showed a complete disruption of left abdominal wall muscles, associated with massive bowel loops herniation. No free air nor other visceral injuries were found. The radiological brain evaluation was negative for neurological injuries. Considering the nature of the trauma, an explorative laparotomy was performed. During the fifth postoperative day, the patient presented neurological side signs with right facial-brachial-crural hemiparesis and expressive aphasia. Head and neck CT scan revealed a lesion of the left common carotid artery with distal embolization of the internal carotid. A left-carotid-axis revascularization procedure and a surgical endarterectomy were immediately performed. Patient was discharged after 20 days without neurological consequences. Physicians should be aware of neck vascular injuries when evaluating patients with multiple trauma, even in neurological asymptomatic patients without seatbelt abrasions of the neck skin.
  
  
  BACKGROUND
  Abdominal Hernia, Carotid artery, Seat belt, Surgery.
authors.forename: Savino
authors.initials: S
authors.lastname: Occhionorelli
authors.forename: Dario
authors.initials: D
authors.lastname: Andreotti
authors.forename: Daniela
authors.initials: D
authors.lastname: Tartarini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cappellari
authors.forename: Rocco
authors.initials: R
authors.lastname: Stano
authors.forename: Lucia
authors.initials: L
authors.lastname: Morganti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Vasquez
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D034861:Abdominal Wall / Q000000981:diagnostic imaging; D000063:Accidents, Traffic; D001037:Aphasia / Q000209:etiology; D020212:Carotid Artery Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D002341:Carotid Artery Thrombosis / Q000209:etiology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal; D057210:Delayed Diagnosis; D016894:Endarterectomy, Carotid; D005260:Female; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000209:etiology; D010291:Paresis / Q000209:etiology; D012622:Seat Belts / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*