Hemoperitoneum secondary to mesenteric laceration after abdominal trauma - Case report

Abstract

Mesenteric laceration is an uncommon cause of hemoperitoneum, with nonspecific signs and symptoms and frequently is camouflaged by the signs of other traumatic lesions. There is a high risk to go unnoticed increasing morbidity and mortality. We report a case of a 43-year-old man, who was involved in a motorcycle accident, with thoraco-abdomino-pelvic trauma, but without evidence of intra-abdominal lesions on exams, with exception of hemoperitoneum. Due to hemodynamic instability , it was performed an exploratory laparotomy. Intraoperative findings were mesenteric lacerations affecting a small bowel segment. This case demonstrates that a high index of suspicion is necessary to diagnose and treat lesions like mesenteric laceration, not visible early on imaging but potentially fatal, with high risk of complications.

Blunt Mesenteric Injury: Two Case Reports

“…In blunt abdominal trauma, mesenteric and bowel trauma is the third most common type of injury, seen in about 5% of cases during laparotomy, and is less common than solid organ injuries [2][3][4][5], in which splenic injury is most frequently encountered and makes 40% of abdominal organ injuries [5]. Solid organ and large vessel injuries account for the majority of cases of hemoperitoneum, while mesenteric laceration is an uncommon etiology of hemoperitoneum [1]. Mesenteric injury is rare, accounting for less than 1% of all injuries [6].…”

“…Clinically, the bowel and mesenteric injuries are difficult to detect due to nonspecific symptoms and signs such as abdominal pain, tenderness, bowel distension, decreased bowel sound, hypotension and even shock [1,4,6,11]. The physician's attention may be distracted when the patient experiences other associated clinical manifestations, such as conscious disturbance due to concomitant head and spinal cord injuries, or hemodynamic change due to concomitant pelvic fractures.…”

“…Blunt abdominal trauma is frequently encountered in the emergency department, leading to intraabdominal injury in 12-15% of cases [1]. Bowel and mesenteric injuries are present in approximately 5% of patients with blunt abdominal trauma at laparotomy [2][3][4][5].…”

“…Small bowel mesentery is injured about five times more common than colonic mesentery (mesocolon) [8]. Mesenteric injury is difficult to diagnose due to nonspecific clinical features, leading to delayed diagnosis, higher morbidity and mortality, and increased length of hospital stay [1,9]. Nowadays, multidetector row CT (MDCT) replaces diagnostic peritoneal lavage and becomes the modality of choice for diagnosing abdominal injuries [2,4,10].…”