A 40-year-old man involved in a high-speed motor vehicle collision has a seat belt sign across his abdomen and lower chest. CT scan shows a Chance fracture of L2 and mesenteric haematoma. Which visceral injury must be most actively sought in this clinical scenario?

• A Splenic laceration
• B Aortic injury
• C Bladder rupture
• D Hollow viscus injury (bowel perforation/tear) ✓

Explanation

The seat belt triad (Chance fracture + mesenteric/bowel injury) is classically associated with hollow viscus injury, particularly small bowel tears and mesenteric disruption, from the rapid deceleration flexion-distraction mechanism. CT may underestimate or initially miss bowel perforations; clinical deterioration, peritonitis, or CT findings of mesenteric streaking, pneumoperitoneum, or bowel wall thickening should prompt urgent laparotomy. Splenic injury is more common in blunt left-sided trauma without seat belt mechanism.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.