INI-CET 2013 — Surgery

Question 1: When a seat belt is worn, if an accident occurs, sudden deceleration can result in:

• A. Rupture of mesentery (Correct Answer)
• B. Liver injury
• C. Spleen injury
• D. Vertebral injury

Explanation: ***Rupture of mesentery*** - The **lap belt** component of a seatbelt causes compression and shear forces across the abdomen during sudden deceleration, leading to the classic **"seatbelt sign"** (abdominal wall ecchymosis). - This mechanism commonly causes **mesenteric tears** and bowel injuries, which represent the **most frequent intra-abdominal injuries** in the seatbelt syndrome. - Mesenteric avulsion can lead to bowel ischemia and perforation, making it a critical injury to identify in restrained trauma patients. *Liver injury* - While liver injury can occur in motor vehicle accidents, it is **less specifically associated** with the seatbelt mechanism. - Liver lacerations typically result from **direct impact** or compression against the rib cage, and are actually **reduced in incidence** with proper seatbelt use compared to unrestrained occupants. - Not a characteristic finding of the seatbelt injury complex. *Spleen injury* - Splenic trauma is similarly more common with **direct lateral impact** to the left upper quadrant rather than the anterior compression from a lap belt. - Proper seatbelt restraint generally **protects** against severe splenic injury compared to unrestrained passengers. - Not part of the classic seatbelt syndrome. *Vertebral injury* - The **Chance fracture** (horizontal fracture-dislocation of the lumbar spine) is indeed a **recognized component of seatbelt syndrome**, caused by flexion-distraction forces over the fulcrum of the lap belt. - However, in the context of seatbelt injuries, **soft tissue injuries** (mesentery, bowel) are **more common** than bony Chance fractures. - When evaluating the "seatbelt complex," mesenteric injury is the **primary visceral injury** to suspect, while Chance fracture represents the associated skeletal injury pattern. - This question focuses on the most characteristic and frequent injury pattern.