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Case Reports in Emergency Medicine
Volume 2018, Article ID 4251408, 4 pages
Case Report

Positive Seatbelt Sign with Avulsed Leiomyoma following Motor Vehicle Accident Leading to Hemoperitoneum

1University of California Davis School of Medicine, 4610 X Street, Sacramento, CA 95817, USA
2Department of Emergency Medicine, University of California, Davis, 2315 Stockton Boulevard, Sacramento, CA 95817, USA

Correspondence should be addressed to Martin A. C. Manoukian; ude.sivadcu@naikuonamam

Received 30 April 2018; Accepted 12 August 2018; Published 26 August 2018

Academic Editor: Aristomenis Exadaktylos

Copyright © 2018 Martin A. C. Manoukian et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A positive seatbelt sign following a motor vehicle accident is associated with an increased risk of intra-abdominal injury and hemoperitoneum. Injury to the uterus in reproductive-age women can also occur. In this report, we describe a 29-year-old nulligravida female who presented to the emergency room following a motor vehicle accident at freeway speeds. A positive seatbelt sign was noted, and a focused assessment with sonography for trauma revealed hemoperitoneum with an incidental finding of uterine leiomyomata. Upon exploratory laparotomy, a free-floating intraperitoneal mass was identified as an avulsed uterine leiomyoma. A uterine laceration containing a subserosal leiomyoma was also identified. The gynecological team was consulted, and a myomectomy of the subserosal leiomyoma followed by a closure of the uterine laceration was performed. The patient was transfused with a total of three units of packed red blood cells and two units of fresh frozen plasma. The postoperative course was without major complication. A positive seatbelt sign and hemoperitoneum in a reproductive-age woman with leiomyomata should increase the clinical suspicion for uterine injury and decrease the threshold for obtaining a gynecological consultation.