Diaphragmatic Rupture Caused by Seatbelt Injury

Abstract

An increasing tendency for the occurrence of traumatic diaphragmatic injury has been noted with a recent increase in traffic accidents. Herein, a case of diaphragmatic rupture associated with a 3-point seatbelt is described. An 82-year-old female was seen at our hospital because of a traffic accident on May 29, 1994. She was a front seat passenger wearing a seatbelt. Physical examination showed dyspnea, abdominal distention and Blumberg's sign. Laboratory data showed her white blood cell count to be as high as 15, 600/μl. An X-ray examination revealed bowel gas in the pleural cavity. Emergency operation was undertaken under a preoperative diagnosis of left diaphragmatic rupture and panperitonitis. At laparotomy, pus-like ascites and a left diaphragmatic rupture measuring 10cm in diameter were revealed. Moreover, the perforation was confirmed to be located in the cecum. Closure of the diaphragmatic rupture and ileocecal resection were performed but she died of cardiac failure one day after the operation. A diaphragmatic rupture associated with an elevation of intraperitoneal pressure, caused by a seatbelt, should be considered in patients with seatbelt injuries.