Complete transverse transection of the normal-sized non-pregnant uterus associated with wearing a safety belt in abdominal blunt trauma: Narrative review and case study.

Abstract

This review and case study illustrates a patient with a complete transverse transection of a non-pregnant uterus caused by blunt trauma associated with wearing a safety belt. The 31-year-old patient, who had a previous cesarean section, presented with impending hypovolemic shock caused by intra-abdominal hemorrhage secondary to blunt trauma while wearing a safety belt. On physical examination, a transverse straight line of ecchymosis along the line of a fastened safety belt was noted without any other external injury. The operative findings revealed a complete transverse transection which had cut through the lower part of the non-pathological, normal-sized uterus with active bleeding and mild injury to the small bowel without active bleeding. Total hysterectomy and simple closure of the small bowel were performed with successful outcomes. We hypothesize that transection was caused by the enormous pressure produced by blunt trauma transmitted through the abdomen by the fastened safety belt and the weakness of the uterine wall caused by the previous low transverse cesarean section which facilitated the separation and extension to the entire wall. In conclusion, this case study provides the following learning points: (1) Enormous forces produced by a fixed fastened safety belt during a car accident can cause complete transverse transection of a normal-sized, non-pathological uterus, leading to life-threatening intra-abdominal hemorrhage. (2) A previous cesarean section may potentiate the transection, especially when the uterus is repositioned above the pelvic brim. (3) The gynecologic condition should also be included in the differential diagnoses in cases of intra-abdominal hemorrhage. If highly suspected, gynecologists should be notified for early recognition and avoidance of delayed actions.