Lessons learned about the management of a traffic road accident victim with abdominal seatbelt sign: Case report

The abdominal seatbelt sign is well described in the literature as an indicative of intra-abdominal visceral injuries; it is considered rare because it is difficult to detect with no single observation providing reliable diagnosis. Consequently, it often presages a delayed diagnosis. We here report lessons from management of 44 year-old man professional driver, victim of a road traffic accident who underwent a damage control laparotomy and whose abdominal seatbelt sign was diagnosed late. To our knowledge, abdominal seatbelt sign has never been reported in a context of rural hospital with low technical facilities. The assessment of the injury revealed haemoperitoneum, rupture of the rectus abdominis, rupture of the appendix and the bowel loop with mesenteric tears. The patient had a second surgery due to a postoperative complication – a postoperative peritonitis with a parietal abscess; this resulted in a digestive fistula which was treated with twice-daily dressing. We learned from the management of this case that presence of an abdominal seatbelt sign in patient with good parameters should lead to paraclinical exploration. So, when faced with the presence of severe abdominal trauma, clinicians should always remember the principles of damage control laparotomy, regardless of the constraints encountered.