シートベルト着用者における小腸損傷６例の検討

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  • SIX CASES OF TRAUMATIC INJURY OF THE SMALL INTESTINE RELATING TO BUCKLED SAFETY BELTS.

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From 1990 to 2001, we treated 6 cases of traumatic injury of the small intestine relating to buckled seat belts in subjects from 18 to 65 years of age, with a male-to-female ratio of 2 to 4. No correct presurgical diagnosis was possible, although signs of peritonitis, intraabdominal free air seen in computed tomography (CT), and intraabdominal fluid retention and thickened bowel seen in CT were obscure immediately after injury. Such findings increased with time. Patients with blunt abdominal trauma, especially those with buckled seat belts, must be careful by examined and closely observed clinically to ensure well-timed surgery for traumatic injury of the small intestine. We assume that the traumatic injury mechanism may be associated with 5 factors: deceleration causing shearing between the relatively fixed proximal and the more mobile distal jejunum, crushing produced between the vertebral column and the seat belt, force transmitted from the anterior abdominal wall, existence of increased small bowel contents, and adhesions from previous laparotomies. Since the seat belt did not necessarily effectively protect the abdomen, more effective air-bag deployment is needed.

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