Transection of the appendix and omentum following a seat belt injury; case report and literature review

INTRODUCTION: Appendiceal injuries following a blunt abdominal trauma are rare. Upon literature review, several cases have been reported to develop appendicitis following blunt abdominal trauma, but total transection of the appendix is extremely rare. CASE PRESENTATION: Our case involves a 24-year-old male restrained driver who was involved in a motor vehicle accident. He had bruising corresponding to the pattern of the seatbelt, the ‘seatbelt sign’, on admission. On his second day of admission, he was found to have a rigid abdomen. On exploratory laparotomy, the patient had a completely transected appendix with a 10 × 10 cm piece of transected omentum lying in the pelvic cavity. DISCUSSION: Literature suggests that seat belts may play a role in the mechanism of injury leading to transection. CONCLUSION: Since the introduction of seatbelt in the 1970s, fatalities from road traffic accidents have fallen by up to 60%. However, the seat belt itself is associated with a unique injury profile, including intestinal tears, perforations, and transections, collectively termed “the seatbelt syndrome”. Seat belt syndrome injuries may sometimes have a delayed presentation, thus repeated abdominal examination is recommended even if the patient is initially stable. Appendiceal transection is rare but may occur. A thorough inspection of the abdominal soft tissue to look for accompanying injuries is important if case an exploratory laparotomy is warranted.