Vascular bowel and mesenteric injury in blunt abdominal trauma: a single centre experience

Tilden, William; Griffiths, M.; Cross, Susan

doi:10.1016/j.crad.2020.09.022

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…In colon and mesocolon injuries, specific findings on physical examination or CT, such as extraluminal fluid collection, discontinuity of the bowel wall, pneumoperitoneum, or bowel infarction, are indications for immediate intervention [9]. However, decision-making is often challenging in patients with colon and mesocolon injuries as there is no clear indications for surgical treatment [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, additional evaluation should be considered in unconscious patients in case of any change in vital signs [15]. It is important to consider the benefits of nonoperative management to the patient and the delay in surgical interven-tion that could increase the rates of morbidity and mortality [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, surgical intervention is considered necessary when hypoenhancement of the bowel wall is observed. However, immediate intervention in hemodynamically stable patients without prominent perforation or necrosis remains questionable [5].…”

Section: Introductionmentioning

confidence: 99%

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Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports

et al. 2022

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The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/ or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports

et al. 2022

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“…The underlying mechanism of mesenteric injury is due to rapid deceleration, compression or crush injuries [9] . Bowel perforations can occur from direct trauma or delayed perforation of the devascularized segment due to necrosis within 48 to 72 h [10] . This is associated with significant morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Bucket-handle mesenteric tear and traumatic abdominal wall hernia following bicycle handlebar injury in an adult: A ‘case report’

Bejiga¹

2023

International Journal of Surgery Case Reports

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“…A mesenteric bucket-handle tear is a traumatic abdominal injury in which avulsion of the mesentery from a segment of the bowel loop occurs and can result in subsequent de-vascularisation, ischaemia, and hollow-viscus perforation [ 1 ]. It has significant associated morbidity and mortality [ 2 ] and accounts for the majority of “missed” bowel and mesenteric injuries [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Bucket-Handle Mesenteric Tears: A Comprehensive Review of Their Presentation and Management

Chowdhury¹,

Burford²,

Pangeni³

et al. 2022

Cureus

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Bucket-handle mesenteric tears remain a diagnostic challenge for clinicians. We aim to review the literature, including a single-surgeon series, to better understand their presentation and management.Three electronic databases (Ovid Medline, Embase, and PubMed) were searched for original research articles, describing relevant cases, from database inception to October 2021 using the following Medical Subject Heading (MeSH) terms: mesenteric avulsion, mesenteric tear, and blunt abdominal trauma. A retrospective review of cases managed under a single surgeon at our unit was also performed. Data extracted included demographics, mechanism of injury, presenting features, diagnostic imaging, surgical management, and patient outcome.In total, 19 studies were identified, including 22 patients (median age 34.5 years). The most common cause of injury was seat-belted road traffic accidents (77.3%), and patients commonly presented with abdominal pain (72.7%), tenderness (50%), positive seat-belt sign (54.5%), and haemodynamic compromise (45.5%). Computerised tomography scanning was the main imaging modality (68%), and the most common findings reported were abdominal free fluid (36.4%) and abdominal wall hernia (27.3%). The majority of patients were operated on within 24 hours of injury (68%), had a median length of stay of 14.5 days, and experienced an uncomplicated recovery (68%). There was no association between the development of complications and delayed surgical intervention >24 hours (p = 0.145). Our institution's experience was similar, with 50% of patients undergoing surgical intervention within 24 hours. The median age was 32.5 years (50% female), and the median length of stay was 11 days.A high index of suspicion, serial monitoring, including blood tests, and imaging, with a low threshold for early repeat imaging, can provide a useful guide for identifying patients with bucket-handle tears.

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Vascular bowel and mesenteric injury in blunt abdominal trauma: a single centre experience

Cited by 8 publications

References 14 publications

Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports

Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports

Bucket-handle mesenteric tear and traumatic abdominal wall hernia following bicycle handlebar injury in an adult: A ‘case report’

Bucket-Handle Mesenteric Tears: A Comprehensive Review of Their Presentation and Management

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