Intra-abdominal seatbelt injury.

The use of seatbelts has significantly decreased the mortality and morbidity of injuries caused by motor vehicle accidents. We present eight patients who sustained severe intra-abdominal injuries peculiar to the use of the seatbelt. Serious injuries to the bowel and mesentery may be present without early symptoms or physical signs and neither CT scanning nor diagnostic peritoneal lavage is fully reliable or accurate in finding the injury. Prompt diagnosis may be difficult and requires a high index of suspicion as well as a determined approach that may include exploratory celiotomy. The presence of a seatbelt sign across the abdomen is not incontrovertible evidence that a laparotomy must be done, but its presence should create a high index of suspicion for serious visceral injury. Delay in diagnosis significantly increases morbidity and is associated with high mortality rates.