The seal-belt syndrome has been referred to injuries of the intestinal viscera and the
lumbar fracture-dislocation following the use of seat belt upon traffic collision.
Children present with a higher frequency of these combinations of injuries than
adults due to an ill-fitting lap. Herein, we report an unusual case of circumferential
ischemic injury of the jejunum with perforation following seat belt trauma in an
adult. The presence of a seat belt sign should always be a reminder of occult injuries
especially within the abdomen. Abdominal sonography and computed tomography
(CT) scan are usually helpful, but the diagnosis of intestinal perforation is still
frequently delayed because this type of injury is always initially subtle with a stable
hemodynamic condition. Therefore close observation with a high index of suspicion
and repeated abdominal examinations should be the rule.