Blunt abdominal trauma and mesenteric avulsion: a systematic review

Kordzadeh, Ali; Melchionda, V.; Rhodes, K. M.; Fletcher, E. O.; Panayiotopolous, Yiannis P.

doi:10.1007/s00068-015-0514-z

Cited by 27 publications

(16 citation statements)

References 24 publications

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“…3) in blunt abdominal trauma often occur in high-speed vehicle accidents frequently due to seatbelt restraints [50•]. A retrospective report by Frick et al [51] showed that 29.7% of mesenteric lacerations lead to bowel devascularization (Fig.…”

Section: For Whom?mentioning

confidence: 99%

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

2017

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The management of blunt abdominal trauma has evolved over time. While laparotomy is the standard of care in hemodynamically unstable patients, stable patients are usually treated by non-operative management (NOM), incorporating adjuncts such as interventional radiology. However, although NOM has shown good results in solid organ injuries, other lesions, namely those involving the hollow viscus, diaphragm, and mesentery, do not qualify for this approach and need surgical exploration. Laparoscopy can substantially reduce additional surgical aggression. It has both diagnostic and therapeutic potential and, when negative, may reduce the number of unnecessary laparotomies. Although some studies have shown promising results on the use of laparoscopy in blunt abdominal trauma, randomized controlled studies are lacking. Laparoscopy requires adequate training and experience as well as sufficient staffing and equipment.

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Section: For Whom?mentioning

confidence: 99%

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

2017

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“…16 Study conducted on 182 cases of peptic ulcer perforations (150 duodenal, 32 gastric) by Fong found that the intraabdominal abscess (22 cases), wound infection (26 cases) and generalized bacterial peritonitis (18 cases) were most common complications. 12,13,17 Our study reveals that the average duration of stay in hospital was nearly same for all cases of gastrointestinal perforation (16.52-18.5 days) so we can conclude that stay in hospital was independent of the cause of gastrointestinal perforation. Average duration stay in hospital was less in patients who were managed conservatively it may be due to their general condition were good and having fewer complications.…”

Section: Discussionmentioning

confidence: 63%

Different modes of treatment and complications associated with non-traumatic gastrointestinal perforation

Mane¹,

Kushwaha²

2018

Int Surg J

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Background: Gastrointestinal (GI) Perforation is an important emergency situation that usually requires prompt surgery. Prompt detection of Gastrointestinal (GI) tract perforation is important for the diagnosis of life-threatening conditions in patients with acute abdomen. A number of causes can lead to Gastrointestinal tract perforations (blunt or penetrating trauma, peptic ulcer, inflammatory disease, foreign body, a neoplasm or iatrogenic factors); and has variable clinical presentations, particularly in the early clinical course. Present study aimed at investigating the different modes of treatment and complications associated with non-traumatic gastrointestinal perforation.Methods: This cross-sectional observational study was carried out on patients of Department of general surgery at Late Lakhiram Agrawal Memorial Government Medical college (LAMGMC) Raigarh, Chhattisgarh, India from September 2014 to August 2016. A total 100 adult subjects (both male and females) of all age groups were included in this study.Results: Operative management (44%), conservative management 38% and 18% of cases were managed with Peritoneal drainage under local anaesthesia (LA). Most common complications of peptic perforation cases were toxaemia (32.3%), wound gaping (17.9%) and respiratory complications (11%). Most common complications of typhoid perforation cases were toxaemia (50%), respiratory complications (32.4%), wound infection (22.2%) and wound gaping (18.5%). Most common complications of Appendicular perforation cases were wound gaping (50%) and toxaemia (40%). The average duration of stay in hospital was 16.52 days. The average duration of stay in hospital of Peptic perforation was 17.3 days, typhoid perforation 18.3 days, Appendicular perforation 18.5 days and for other perforation was 12 days.Conclusions: Majority of the cases undergone for operative management and most frequently developed complications were toxaemia followed by wound gaping and respiratory complications. The average duration of stay in hospital was nearly same for all cases and the stay was less in patients who were managed conservatively.

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“…Upon considering similar mechanisms of mesenteric laceration, Heimlich maneuver for choking, rope wounds across the waist in the game of "tug of war", and seatbelt injuries are reported as possible culprits of mesenteric injury [5,9,10]. The common point of these traumas including our case to cause mesenteric laceration is a rapid elevation of the intra-abdominal pressure conveyed to the stalk of the mesentery.…”

Section: Discussionmentioning

confidence: 72%

“…After removal of a fist-sized hematoma and a large amount of intraabdominal hemorrhage, approximately 5 cm in length of a mesenteric laceration in the transverse colon adjacent to the left side of Treitz's ligament was revealed. Hemostasis was achieved by suture ligations but repair of the laceration was impossible because the tissue was too fragile mesenteric laceration is very rare and theoretically seldom happens because external forces need to be conveyed directly to the mesentery in the abdominal trauma cases [5].…”

Section: Discussionmentioning

confidence: 99%

Laceration of the transverse mesocolon in an old man with a habit of abdominal massage for constipation: a case report

Mori

Otomo

2020

surg case rep

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Background: Abdominal massage for the resolution of constipation has been reported to be safe and recommended in some studies. It is conventionally performed for the elderly suffering from intractable constipation. Meantime, isolated mesenteric injury after blunt abdominal trauma is uncommon. Here, we report a case of isolated mesenteric injury following self-abdominal massage for constipation. Case presentation: A 68-year-old man consulted a local hospital due to a sudden abdominal pain. He had a history of prostate cancer treated with radiation therapy 3 years ago, and he had been suffering from chronic constipation for many years. A plain computed tomography (CT) revealed a fist-sized homogeneous mass-like lesion located in the left upper abdomen and a moderate amount of ascites. With the initial diagnosis of a malignant tumor accompanied by peritonitis carcinomatosa, he was hospitalized for further examinations. On the next day, his hemoglobin concentration dropped from 11.6 to 6.6 g/dl, and diagnostic paracentesis showed bloody ascites. He was urgently transferred to our tertiary emergency center. An enhanced CT demonstrated a non-enhanced, homogeneous, 8.5 cm in diameter, mass lesion located to the posterior of the stomach with massive bloody ascites. He underwent an emergency exploratory laparotomy, and it showed a 5 cm of laceration in the transverse mesocolon adjacent to Treitz's ligament and approximately 1.5 l of intraabdominal hemorrhage. Hemostasis of the bleeding from the laceration was achieved by suture ligations, but the gap of the laceration could not be closed by suturing because the tissue was too fragile. Blood transfusion with 4 units of packed red blood cells and 10 units of fresh frozen plasma was performed during operation. He was discharged without any significant complications except for postoperative paralytic ileus. Later on, it turned out that he had a habit of massaging his abdomen for the resolution of intractable constipation and did it hard 1 day before the onset. Conclusions: This is the first report of life-threatening mesenteric injury caused by self-abdominal massage to resolve constipation, though other etiologies such as rupture of small aneurysms could not perfectly be excluded. Abdominal massage is reported to be effective and safe for the resolution of constipation; however, this case demonstrated it could be detrimental.

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Blunt abdominal trauma and mesenteric avulsion: a systematic review

Abstract: Mesenteric avulsion is rare and has a complex and vague presentation. Due to its potential mortality and morbidity, emergency physicians should keep a high index of suspicion in individuals with blunt abdominal trauma from any mechanism of injury.

Cited by 27 publications

References 24 publications

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

Different modes of treatment and complications associated with non-traumatic gastrointestinal perforation

Laceration of the transverse mesocolon in an old man with a habit of abdominal massage for constipation: a case report

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