Bucket handle injury of small bowel: a case report

Abstract

Hollow viscus or mesenteric injuries account for 1-6% of injuries in a patient with blunt abdominal trauma. A 63-year-old male, presented with a history of tree fall while he was on a two-wheeler. With a history of left hip pain and abdominal pain, examination revealed he was tachycardic, normotensive with abrasions and dislocation of left hip joint. Abdomen examination revealed diffuse tenderness with sluggish bowel sounds with blood at the meatus. FAST was positive. CECT showed mesenteric hematoma, intra-peritoneal rupture of bladder and multiple pelvic fractures. Laparotomy revealed a rent in the anterior wall and neck of urinary bladder, which was repaired along with a bucket handle tear of mesentery, 40 cm from ICJ, with gangrene of ileum which required resection anastomosis. Post-operative period was uneventful. Rapid deceleration in a road traffic accident causes shearing forces between segments of bowel fixed in the retroperitoneum and the more mobile peritoneal segments, which leads to avulsion of mesentery from the bowel known as bucket handle injury. These are traumatic ischemic injury, which require urgent surgical intervention. Due to the varying CT findings, a pre-operative diagnosis is very challenging and required high index of suspicion. Prompt diagnosis and surgical management is required to prevent delayed complications in bucket handle injuries of bowel.