Seat-belt sign (SBS) is the pattern of thoraco-abdominal ecchymosis in distribution of seat-belt and considered to be strongly associated with intestinal injuries.  Herein, an 11-year-old boy who had bowel avulsion was presented to discuss the use of computed tomography (CT) in the diagnosis of seat-belt injury in children. An 11-year-old boy was brought to the emergency room because of high-speed motor vehicle crash. His general condition was good. He had mild abdominal tenderness and a seat-belt bruising on his belly. The first laboratory examinations, chest and abdominal X-rays revealed normal findings. Abdominal ultrasound showed minimal free fluid. Since physical examination revealed ongoing tenderness, CT was performed. A large defect in abdominal fascia and disruption in sigmoid colon integrity were detected in CT. The patient underwent emergent exploration revealing disruption in fascia and avulsion in small and large intestine. The postoperative course was uneventful. Seat-belt injury is a rare type of pediatric trauma and may cause severe bowel injury. The diagnosis of bowel avulsion due to seat-belt injury can be challenging in the absence of free sub-diaphragmatic air in abdominal X-rays. CT should be performed if other radiologic interventions are not compatible with the physical findings.

Keywords: Contusion, Thoracic injuries