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An 11 year old girl was sitting with lap belt only in the back seat of a minivan involved in a motor vehicle accident where her car was rear-ended. She has a “seat belt sign,” or ecchymosis over her lower abdomen. Her CT abdomen with contrast is normal, but she continues to have tenderness to palpation. However, she states she is hungry.
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May 30, 2018 at 12:51 am
B) Admit for serial exams. Seatbelt ecchymoses are associated with visceral and hollow viscus injuries, and the CT may be normal in a patient with a bowel perforation. Signs of peritonitis can develop over time, and patients with ongoing abdominal tenderness should be observed with serial exams. The hyperflexion injury associated with lapbelt-only sitting and seatbelt ecchymoses may result in Chance fracture, a horizontal spinous fracture through the vertebral body, but this would cause back pain.