A restrained front seat passenger in a road traffic accident has a linear ecchymosis across the lower abdomen from the lap belt (seatbelt sign) and complains of increasing abdominal pain over four hours. She is haemodynamically stable with mild tenderness but no peritonism. Which intra-abdominal injury is most characteristically associated with this finding?

• A Traumatic rupture of the right hemidiaphragm
• B Subcapsular haematoma of the liver
• C Intraperitoneal bladder rupture
• D Rupture of the jejunum at the antimesenteric border ✓

Explanation

The seatbelt sign indicates compression of abdominal viscera between the belt and the vertebral column. Hollow viscus perforation, classically jejunal rupture near the ligament of Treitz or at the antimesenteric border, and mesenteric tears are the signature injuries. Because initial examination may be benign, stable patients warrant CT with careful follow up, since delay in diagnosing bowel injury increases septic morbidity.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.