Early Imaging Identification of Traumatic Mesenteric and Bowel Injury: An illustrative case of bucket-handle mesenteric avulsion injury with delayed presentation as small bowel obstruction

Abstract

Traumatic small bowel and mesenteric injuries (SBMI) are uncommon sequelae of blunt trauma. Imaging findings in SBMI can be subtle with varying degrees of sensitivity and specificity, requiring a high level of suspicion given the high associated morbidity and mortality. Imaging findings include seat-belt distribution subcutaneous edema, flexion-distraction fractures, free fluid without a source, asymmetric bowel wall thickening, interloop edema, bowel ischemia, pneumoperitoneum, and even delayed bowel obstruction. A specific subtype of SBMI is an avulsion injury of the small bowel mesentery, which is described as a “bucket handle” defect within surgical literature. This case report highlights the temporal evolution of imaging findings present in cases of traumatic SBMI and is illustrative of how those clinical and imaging findings can inform management decisions.