Blunt abdominal trauma and mesenteric avulsion: a systematic review.

Abstract

The aim of this study is to establish the biomechanics, presentation and diagnosis of mesenteric avulsions following blunt abdominal trauma and reach a consensus on their overall management. A systematic review of literature in MedLine, Embase, Scopus and CINHAL in English language from 1951 to November 2014 was performed. A total of 20 reported cases were identified. Variables including patient's demographics, signs and symptoms, mechanism of injury, investigative modality, management, length of stay, follow-up and outcomes were reviewed and analyzed. The median age of the cohort was 28.5years (range 10-58years), with a male-to-female ratio of 3:1. The commonest mechanism of injury was road traffic accident due to seat belt restraint (n=12, 60%). The commonest presentation was diffuse abdominal tenderness (n=10, 45%) followed by ecchymosis/bruising (n=9, 40%). Computed tomography (CT) remained the investigative modality of choice (n=9, 45%). All cases had an emergency exploratory laparotomy (n=18, 90%) within the initial 24h and the median length of stay was 19days (range 4-90days). The overall mortality was 15% (n=3). 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.