Types and site distributions of intestinal injuries in seat belt syndrome

Intestinal injuries in seat belt syndrome are relatively uncommon but can be potentially lethal due to accompanying peritonitis and hemorrhaging. It can be difficult to identify the exact injury sites of the intestine as multiple areas are often damaged and massive intraperitoneal hemorrhaging may make it challenging to determine causal bleeding points of mesenteric injuries. This study aimed to clarify the incidence and distribution of intestinal injuries in seat belt syndrome. We retrospectively reviewed the clinical records of 25 patients who underwent laparotomy for suspected intestinal injuries due to seat belt syndrome during a frontal impact. The incidence and distribution of the sites of intestinal injuries, as well as associated injuries, were investigated. Intestinal injuries were divided into bowel and mesenteric injuries. Additionally, bowel injuries were classified into two types: perforation and non-perforation (seromuscular tears/intramural hematomas). Regarding the injured sites, the small intestine was divided into the following three parts: (1) the ligament of Treitz (100-cm distal from the ligament [proximal jejunum]), (2) the ileocecal valve (100-cm proximal from the valve [distal ileum]), and (3) the intermediate area between those two regions (jejunoileal junction). In total, there were 64 major injuries among 25 patients requiring surgical intervention: 34 bowel injuries (20 perforations and 14 non-perforations) and 30 mesenteric injuries. Significantly more bowel perforations occurred in the small intestine (1 [interquartile range (IQR), 0–1]) than in the large intestine (0 [IQR, 0–0]) (p = 0.003). Similarly, significantly more mesenteric injuries occurred in the small intestine (1 [IQR, 0–1.25]) than in the large intestine (0 [IQR, 0–0]) (p p = 0.015). In patients with seat belt syndrome, the small intestine was more vulnerable to perforation and mesenteric injury than the large intestine. Additionally, for mesenteric injuries, the jejunoileal junction was more likely to be damaged than the proximal jejunum.安全带综合征（seat belt syndrome）相关肠道损伤相对少见，但因伴随腹膜炎与大出血，可具有致命风险。由于肠道常存在多区域损伤，且大量腹腔内出血可能难以明确肠系膜损伤的出血源头，精准识别肠道损伤部位颇具挑战。本研究旨在明确安全带综合征患者肠道损伤的发生率与分布特征。我们回顾性分析了25例因疑似安全带综合征导致肠道损伤、于正面碰撞后接受剖腹手术的患者的临床病历。研究对肠道损伤部位的发生率与分布特征，以及合并损伤情况进行了调查。肠道损伤分为肠道损伤与肠系膜损伤两类；其中肠道损伤又可分为穿孔与非穿孔（浆肌层撕裂/壁内血肿）两种亚型。关于损伤部位，小肠被划分为以下三部分：(1) 屈氏韧带（ligament of Treitz）（距该韧带远端100cm区域，即近端空肠）；(2) 回盲瓣（ileocecal valve）（距该瓣膜近端100cm区域，即远端回肠）；(3) 上述两区域之间的中间区域（空回肠交界区（jejunoileal junction））。25例需手术干预的患者中共计存在64处主要损伤：34处肠道损伤（20处穿孔性损伤、14处非穿孔性损伤）与30处肠系膜损伤。小肠部位的肠道穿孔发生率[1（四分位距（interquartile range, IQR），0–1）]显著高于大肠[0（四分位距（interquartile range, IQR），0–0）]（p=0.003）。同理，小肠部位的肠系膜损伤发生率[1（四分位距（interquartile range, IQR），0–1.25）]显著高于大肠[0（四分位距（interquartile range, IQR），0–0）]（p=0.015）。在安全带综合征患者中，小肠相较于大肠更易发生穿孔与肠系膜损伤。此外，针对肠系膜损伤而言，空回肠交界区较近端空肠更易受损。