シートベルト損傷による結腸肝わん曲部破裂の２例

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  • Two Cases of Bowel Rupture at the Hepatic Flexure of Colon from a Seat Belt Injury.

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We report two patients who had bowel rupture at the hepatic flexure of colon from a seat belt injury. Patient 1 and Patient 2 were a 77- and a 72-year-old women, respectively. Both of the patients met with a traffic accident in the seat next to the driver, bucking up the three-pointed belt. In our patients, bowel rupture was accompanied by the fracture in the right upper limb, rib fractures, and hemothorax. They underwent an abdominal surgery immediately after the rupture was diagnosed. We found a 5mm perforation on the antimesenteric surface of the hepatic flexure of colon in Patient 1, and Patient 2 had a 4.5cm-long tear in the same portion as Patient 1. A simple closure of the perforation for Patient 1 and a partial colectomy for Patient 2 gave good results. We suppose that the mechanism of bowel rupture at the hepatic flexure might be associated with the following three factors; 1. the maximum of direct force on the right sided portion of horizontal belt, 2. anatomical reasons that the flexure situates relatively higher than the other portion of colon in sitting position and that the flexure is fixed by ligament, and 3. existence of stool.

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