Peritonitis following duodenal injury due to seatbelt trauma: A case manifesting immediately post-surgery for thoracolumbar fracture-dislocation.

Introduction: Although abdominal organ damage due to motor vehicle accident is often evident immediately after the injury and urgent operation is performed, it has been reported that minor injuries such as hollow viscus may become apparent during the course of treatment and require urgent surgery.

Case Report: The Authors present the case of a 42-year-old female who developed peritonitis immediately after undergoing surgery for thoracolumbar fracture-dislocation caused by a traffic accident. The patient exhibited no abdominal symptoms, such as nausea, vomiting, or abdominal wall rigidity, and had no difficulty with oral intake preoperatively. The patient was consulted to an abdominal surgeon, who proceeded with an emergency surgery. Intraoperatively, the duodenal injury was identified and meticulously repaired. Postoperatively, the patient was transferred to the intensive care unit for ongoing critical care management. By postoperative day 60, the patient was able to walk independently and was discharged.

Discussion: Preoperative diagnosis of patients with delayed bowel obstruction due to seat belt injuries poses a challenging task for surgeons. The diagnosis and treatment of isolated duodenal injuries has been reported to be difficult because of the retroperitoneal organ. In the clinical management of seatbelt injuries, attention should not be exclusively directed toward the more conspicuous spinal fractures, but the possibility of concomitant bowel injuries must also be carefully considered.

Conclusion: Treatment should be carried out with the awareness that intestinal injuries may be present, even in the absence of abdominal symptoms during the initial examination.