Chance fracture at L2 followed by delayed jejunal transection due to a motor vehicle collision: A case report and review

Abstract

Chance fractures are rare lesions but are often associated with abdominal injuries. We present a case of a 21-year-old patient who sustained a delayed type of abdominal injury associated with a bonny Chance fracture of lumbar 2nd following a traffic accident. Initial X-rays and computed tomography (CT) scans showed a Chance fracture with subtle bowel images, evading the prompt diagnosis of bowel injuries. However, the toxic signs were presented after 17h of stay in intensive care unit, and hollow visceral perforation was diagnosed in the re-do abdominal CT scanning. The laparostomy with primary anastomosis was performed for complete transection of the middle part of the jejunum. After a follow-up period of 20 days, the patient underwent kyphoplasty, accompanied by posterior fusion of the L1–L3 vertebrae and was found well recovered at 2 weeks follow-up. Clinicians should realize the subtle but meaningful imaging signs to allow prompt diagnosis as well as management when meeting patients with seatbelt sign associated with Chance fracture after a traffic accident.

Keywords

• Seatbelt injury
• Janus sign
• Motor-vehicle collision
• Delayed bowel and mesentery trauma
• Chance fracture