Mesenteric Avulsion Research Articles

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

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.

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

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.

Successful Damage Control Resuscitation with Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pediatric Patient

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

CT evaluation of mesenteric avulsion after abdominal blunt trauma in a dog

A 10‐month‐old German shepherd dog was presented following blunt abdominal trauma with evidence of circulatory shock. Abdominal ultrasonography and abdominocentesis confirmed a haemoabdomen. CT findings were consistent with active arterial abdominal bleeding secondary to mesenteric or splenic vessel rupture with a large haematoma visible in the region of the mesenteric root. The dog was stabilised prior to exploratory coeliotomy. This confirmed active haemorrhage of the cranial mesenteric artery and devitalisation of a large section of jejunum and ilium. The affected mesenteric vessels were ligated, and the affected intestinal segment was resected. While recovering from anaesthesia, the dog developed ventricular fibrillation. Cardiopulmonary resuscitation was unsuccessfully attempted. With the increasing use of CT in veterinary trauma patients, the recognition of the features of blunt bowel and mesenteric injury is crucial for a successful diagnosis and management of these conditions.

Mesenteric avulsion: A systematic review of literature

Mesenteric avulsion: A systematic review of literature

Inflammatory myofibroblastic tumor masquerading as perforated appendicitis

Inflammatory myofibroblastic tumor (IMT) is a rare and histologically benign tumor that most commonly presents in pediatric patients. Abdominal IMTs often present with non-specific symptoms, and therefore they can masquerade as other more common abdominal conditions. This report describes two cases of IMT presenting as perforated appendicitis. Both cases are of young children who presented with over 48 hours of abdominal pain and who had peritonitis on examination. Pre-operative ultrasounds for both patients revealed complex free fluid. Laparoscopic evaluation demonstrated hemoperitoneum, and further exploration revealed mesenteric avulsion with abnormally thickened mesentery. Pathology confirmed IMT arising from the small bowel mesentery in both cases. Both children underwent limited bowel resection and were discharged in stable condition on a course of non-steroidal anti-inflammatory drugs (NSAIDs). Given the association of avulsed bowel to trauma, non-accidental trauma was suspected in both cases and demonstrated in one. Both patients showed complete resolution of tumor on follow-up MRI. The diagnosis of IMT must always be considered when an intra-abdominal mass is encountered as its treatment differs greatly from other neoplasms.

Blunt abdominal trauma and mesenteric avulsion: a systematic review.

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.

Biomechanical analysis of traumatic mesenteric avulsion.

Mesenteric avulsion, corresponding to a tearing of intestine's root, generally results from high deceleration in road accidents. The biomechanical analysis of bowel and mesenteric injuries is a major challenge for injury prevention, particularly because seat belt restraint may paradoxically increase their risk of occurrence. The aim of this study was to identify the biomechanical behavior of mesentery and small bowel (MSB) tissue samples under dynamical loading conditions. A dedicated test bench was designed in order to perform tensile tests on fresh MSB porcine specimens, with quasi-static (1 mm/s) and dynamic (100 mm/s) loading conditions. The mechanical behavior of MSB specimens was investigated and compared to isolated mesenteric and isolated small bowel specimens. The results show a high sensitivity of MSB stiffness (1.0 ± 0.2 and 1.3 ± 0.3 N/mm at 1 and 100 mm/s, p = 0.001) and ultimate force (22 ± 5 and 35 ± 8 N at 1 and 100 mm/s, p = 0.001) to the loading rate but not for the displacement at failure. This leads to postulate on a failure criteria based on strain level regardless of the strain rate. These experimental results could be further used to develop refined finite element models and to further investigate on injury mechanisms associated to seat belt restraints, as well as to evaluate and improve protective devices.

Subtle mesenteric avulsion in a traumatic abdominal wall hernia: A case report

INTRODUCTIONTraumatic abdominal wall hernias (TAWHs) are uncommon and to date less than 50 cases have been reported in the literature. Furthermore mesenteric avulsion is a rare complication of TAWHs and occurs in less than 5% of all cases. PRESENTATION OF CASEA 47-year-old lady presented to the emergency department after a road traffic accident. In spite of seat belt use and airbag deployment, the patient presented with a visible left paramedian abdominal mass, which was tender and irreducible on examination. Subsequent computed tomography (CT) of the abdomen confirmed herniation of the small bowel with no free air or fluid in an otherwise stable patient. Intra-operative findings confirmed mesenteric avulsion and bowel necrosis. DISCUSSIONThe role of emergency or elective repair of TAWHs remains unclear. As 58% of blunt mesenteric and bowel injuries due to avulsion are missed on initial work-up, it is advisable for clinicians to balance the risk of unnecessary and non-therapeutic emergency laparotomy with the morbidity and mortality associated with delay in diagnosis. CONCLUSIONMesenteric avulsion in TAWH is rare and difficult to diagnose and a high index of suspicion is warranted despite normal findings on initial assessments.

Acute Mesenteric Avulsion from the Small Bowel after Double Balloon Enteroscopy - A Never Before Described Complication

Acute Mesenteric Avulsion from the Small Bowel after Double Balloon Enteroscopy - A Never Before Described Complication

Delayed repair for traumatic abdominal wall hernia: is it safe?

Abdominal wall hernias after trauma have been recognized for more than a century, with the first case reported as occurring after a fall. Traumatic abdominal wall hernias (TAWHs) after blunt trauma are uncommon. The timing of definitive repair, early or delayed, is not clear. We report a case on TAWH and mesenteric avulsion, highlighting the reasons for immediate or delayed repair. A single case study can hardly be considered as a basis for profound changes in the management of post traumatic hernias. However, damage to all layers of the abdominal wall indicates high-energy trauma. In such cases, the damage is not, in all probability, limited to the integumentary system. For the moment, the timing of surgery in any TAWH should be considered differently according to the trauma, the wall defect, clinical and radiological findings, associated injuries, and the clinical status of the patient.

Traumatic Mesenteric Avulsion and Subsequent Septic Peritonitis in a Dog

Abstract Objective: Description of a case of traumatic mesenteric avulsion in a dog resulting in septic peritonitis. Case Summary: A young dog was presented after having been hit by a car. On initial evaluation, intra‐abdominal injury was not apparent. The dog was discharged and re‐presented with septic peritonitis due to devitalized bowel from mesenteric avulsion. Surgical intervention and supportive care resulted in a successful outcome. New or Unique Information Provided: Successful management of a rare injury including exploratory celiotomy with intestinal resection and anastomosis, supportive care, and closed suction abdominal drainage. (J Vet Emerg Crit Care 2001; 11(3): 211–215)

Microvascular Repair of Jejunal and Ileal Vessels for Near Complete Mesenteric Avulsion after Seat-Belt Injury

Microvascular Repair of Jejunal and Ileal Vessels for Near Complete Mesenteric Avulsion after Seat-Belt Injury

TRAUMATIC VENTRAL ABDOMINAL HERNIA ASSOCIATED WITH SMALL BOWEL GANGRENE

A rare case is presented of traumatic subcutaneous rupture of the rectus abdominis with ventral herniation and decollement of the jejunum and transverse colon. Irreversible ischemia of the small bowel had occurred following a large mesenteric avulsion. Computed tomographic scanning detected the parietal defect and identified the herniating viscera.

Myoelectric activity differences in acute and chronic models of lamb intestinal atresia

Clinical and experimental investigations of intestinal atresia have reduced mortality and clarified etiology. However, the morbidity of this lesion remains excessive and its pathophysiology uncertain. The purpose of this project was to produce the first long-term model of intestinal atresia and thereby to study the motility of the adapting bowel. Intestinal atresia was induced in nine fetal lambs at midgestation by mesenteric avulsion. At term, this experimental group and eight control lambs underwent resection with anastomosis, decompression gastrostomy, and implantation of electrodes proximal and distal to the anastomosis. Vigorous resuscitation and constant intensive care were critical for survival. Slow wave activity (SWA) and spike potential activity (SPA) were recorded in the first 24 hours and every 48 hours thereafter for a 6-hour interval. Three of nine lambs with atresia and five of the eight control animals survived over 48 hours (chronic). Analysis of 220 hours of recording showed, in the first 24 hours of life, a statistically significantly different SWA of 16.4 cycles/min (+/- 1.15 SD) in the chronic atretic survivors compared with 13.1 cycles/min (+/- 2.6 SD) in the acute (died less than 48 hours) atretic group (P less than .05). The SWA of the chronic atretic survivors was similar to the SWA of the chronic nonatretic control animals, 15.1 cycles/min (+/- 1.4 SD). SPA was present on the first day of life in the microintestine of the chronic atresia group in contrast to the acute animals of this study and of Doolin and Hill's previous study. Delayed function has been attributed to the absence of SPA in the microintestine of acute models.(ABSTRACT TRUNCATED AT 250 WORDS)