In contrast, if it was empty, a larger force is required to cause its rupture [15, 16]. In cases of delayed diagnosis of large bowel perforation, Hartmann’s

procedure is safer and more effective [17]. Delayed diagnosis of intestinal perforation increases the incidence of sepsis and its associated morbidity and mortality [10, 18]. Primary closure of the abdominal fascia is ideal but buy SYN-117 it was impossible in our patient. The development of abdominal compartment syndrome was a real concern because of the distension and oedema of the inflamed bowel. The abdomen was left open and gradually closed [19]. The technique we have used is cheap, controls fluid and heat loss, does not adhere to the abdominal wall and simplifies re-exploration of the abdomen with decreased mortality [20]. Despite that, the abdominal domain may be lost as the edges may retract with a risk of evisceration if the abdominal wall closure was delayed [19, 20]. Conclusions The presence of a

seatbelt sign and Selleck mTOR inhibitor a lumbar fracture should raise the suspicion of a bowel injury. Seatbelt injury can cause rectal perforation. Repeated serial clinical examination is essential to avoid missed bowel perforations. Consent Written informed consent was obtained from the patient for the publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal. References 1. Wotherspoon S, Chu K, Brown AF: Abdominal injury and the seat-belt sign. Emerg Med (Fremantle) 2001, 13:61–5.CrossRef 2. Fries J, Jensen AL, Hillmose LA: Perforation

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