Trauma of the mesentery. Anatomy and diagnosis

Iulian Slavu 1 , Adrian Tulin 1 , Dan Păduraru 2 , Bogdan Socea 3 , Vlad Braga 4 , Octavian Enciu 5 , and Lucian Alecu 1
  • 1 “Prof. Dr. Agrippa Ionescu” Clinical Emergency Hospital, , Bucharest, Romania
  • 2 Bucharest University Emergency Hospital, , Bucharest, Romania
  • 3 “Sf. Pantelimon” Emergency Hospital, , Bucharest, Romania
  • 4 Clinical Emergency Hospital, , Bucharest, Romania
  • 5 “Elias” Clinical Emergency Hospital, , Bucharest, Romania

Abstract

Mesenteric lesions in abdominal trauma are encountered in 3% of the cases. Diagnosis of these lesions is difficult, which translates into important delays until surgery that affects patient survival. The short-term consequences of mesenteric lesions translate in bowel ischemia or important blood loss. If a lesion is confirmed after imagistic investigations, one must have complete knowledge of the anatomy and the particular distribution of the main arterial and venous trunks to predict the region of the small bowel that will have to be observed or resected if surgery is required. The aim of our study was to demonstrate this particular distribution of blood vessels through cadaver dissection and to note the resources available to diagnose such lesions.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Cho HS, Woo JY, Hong HS, Park MH, Ha HI, Yang I, Lee Y, Jung AY, Hwang JY. Multidetector CT findings of bowel transection in blunt abdominal trauma. Korean J Radiol. 2013; 14 (4):607–615. doi:10.3348/kjr.2013.14.4.607.

  • 2. Zingg T et al. Avoiding delayed diagnosis of significant blunt bowel and mesenteric injuries: Can a scoring tool make the difference? A 7-year retrospective cohort study. Injury. 2017; http://dx.doi.org/10.1016/j.injury.2017.09.004.

  • 3. Hughes TM, Elton C. The pathophysiology and management of bowel and mesenteric injuries due to blunt trauma. Injury. 2002; 33:295–302.

  • 4. Patlas MN, Alabousi A, Scaglione M, Romano L, Soto JA. Cross-sectional imaging of nontraumatic peritoneal and mesenteric emergencies. Can Assoc Radiol J. 2013; 64(2):148–153. doi: 10.1016/j.carj.2013.02.001.

  • 5. Hawkins AE, Mirvis SE. Evaluation of bowel and mesenteric injury: role of multidetector CT. Abdom Imaging. 2003; 28:505–514.

  • 6. Drost TF, Rosemurgy AS, Kearney RE, Roberts P. Diagnostic peritoneal lavage: limited indications due to evolving concepts in trauma care. Am Surg. 1991; 57:126–128.

  • 7. Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D. Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma. 2000; 48:408–14.

  • 8. Fakhry SM, Watts DD, Luchette FA, Group EM-IHVIR. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial. J Trauma. 2003; 54:295–306.

  • 9. Li T, Robertson-More C, Maclean AR, Dixon E, Navsaria P, Nicol AJ et al. Bowel obstructions and incisional hernias following trauma laparotomy and the nonoperative therapy of solid organ injuries: a retrospective population-based analysis. J Trauma Acute Care Surg. 2015; 79:386–92.

  • 10. McNutt MK, Chinapuvvula NR, Beckmann NM, Camp EA, Pommerening MJ, Laney RW et al. Early surgical intervention for blunt bowel injury: the Bowel Injury Prediction Score (BIPS). J Trauma Acute Care Surg. 2015; 78:105–11.

  • 11. Körner M, Krötz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current role of emergency US in patients with major trauma. Radiographics. 2008; 28(1):225–242. doi:10.1148/rg.281075047.

  • 12. Yu J, Fulcher AS, Turner MA, Cockrell C, Halvorsen RA. Blunt bowel and mesenteric injury: MDCT diagnosis. Abdominal Imaging. 2011; 36(1):50–61. doi:10.1007/s00261-009-9593-9.

  • 13. Park MH, Shin BS, Namgung H. Diagnostic performance of 64-MDCT for blunt small bowel perforation. Clin Imaging. 2013; 37(5):884–888. doi: 10.1016/j.clinimag.2013.06.005.

  • 14. Scaglione M, Linsenmaier U, Schueller G. Emergency radiology of the abdomen. 2012, Berlin, Springer Gmbh.

  • 15. Wu CH, Wang LJ, Wong YC, Fang JF, Lin BC, Chen HW, Huang CC, Hung SC. Contrast-enhanced multiphasic computed tomography for identifying life-threatening mesenteric hemorrhage and transmural bowel injuries. J Trauma. 2011; 71(3):543–548. doi:10.1097/TA.0b013e3181fef15e.

  • 16. Hanks PW, Brody JM. Blunt injury to mesentery and small bowel: CT evaluation. Radiol Clin North Am. 2003; 41(6):1171–1182.

  • 17. Scaglione M, Romano L, Bocchini G, Sica G, Guida F, Pinto A, Grassi R. Multidetector computed tomography of pancreatic, small bowel, and mesenteric traumas. Semin Roentgenol. 2012; 47(4):362–370. doi:10.1053/j.ro.2012.05.005.

  • 18. Dowe MF, Shanmuganathan K, Mirvis SE, Steiner RC, Cooper C. CT findings of mesenteric injury after blunt trauma: implications for surgical intervention. AJR Am J Roentgenol. 1997; 168:425–8.

OPEN ACCESS

Journal + Issues

Search