Mesenteric Injury Research Articles

Dual-Energy CT in the Acute Setting: Bowel Trauma.

Traumatic bowel and mesenteric injuries (TBMI) have significant morbidity and mortality. The physical examination is often limited and sometimes not feasible in the trauma patient. Multidetector CT (MDCT) detection of TBMI is challenging and can be life-saving. Dual-energy CT (DECT) utilizes iodine overlay, monoenergetic imaging, and metal artifact reduction to enhance the conspicuity of TBMI. DECT may improve the conspicuity of TBMI leading to increased diagnostic accuracy and confidence. The aim of the article is to review the state of the art and applications of DECT in bowel trauma.

Hemorrhagic Shock Caused by Mesenteric Injury - Ski Pediatric Blunt Abdominal Trauma case report

Trauma is the leading cause of pediatric mortality and abdominal injury is a significant contributor to morbidity. Abdominal trauma in the population of injured children, is the third leading cause of death in this population, after head and thoracic injuries. It is the most common cause of death owing to unrecognized injury. They most often occur in traffic accidents, games and sports. The clinical presentation depends on the severity of the injury, the injured organ and the associated injuries. Mesenteric injury from blunt abdominal trauma is uncommon and can be difficult to diagnose. It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. We present an unusual case, a seven-year-old boy who was injured while skiing. The patient was in a state of hemorrhagic shock and underwent emergency surgery after an urgent diagnosis. During the operation, the leading trauma and the reason for the hemorrhagic shock were found to be a mesenteric injury, and bleeding from the branches of the superior mesenteric artery. Early transport, monitoring and diagnostics significantly contribute to reducing morbidity and mortality. The standard in surgery is non-operative treatment of injured parenchymal organs. A multidisciplinary approach that includes doctors of various specialties (pediatric surgeons, pediatricians, neurosurgeons, anesthesiologists and radiologists) who contribute to the diagnosis and treatment of injured children through diagnostic and therapeutic procedures has a key role. At the end, the decision regarding surgical treatment is responsibility of pediatric surgeon.

AN ISOLATED MESENTERIC INJURY DUE TO BLUNT TRAUMA ABDOMEN CAUSINGGANGRENE OF SMALL BOWEL

Hollow viscous injury and mesenteric vascular injury after a blunt trauma abdomen although may be third most common injury , occurs only in 3 to 5 % of patients making it a rare entity. Significant mesentric injury includes disruption of mesenteric, active mesenteric bleeding, and mesenteric injury leading to gangrenous bowel.A 56 year old male was brought to the emergency room with history of road traffic accident with no external injuries.On presentation his vitals were stable , examination of abdomen revealed tense abdomen with guarding and rigidity. Given the hemodynamic stability of the patient CT scan of abdomen was done which revealed intraperitoneal free fluid , normal solid organs, abnormal bowel wall enhancement with extraluminal air pockets.Patient underwent emergency laparotomy to find out a massive hemoperitoneum with long segment gangrenous illeal bowel loop. Gangrenous bowel segment was resected and double barrel ileostomy was fashioned. The mechanism of injury involved is either direct compression forces or shearing and deceleration forces in Blunt trauma abdomen.Undiagnosed mesenteric injuries are associated with high morbidity and mortality rates due to life-threatening haemorrhage from disruption of mesenteric vessels, bowel infarction and peritonitis . This can be avoided by using imaging investigations af earliest and emergency surgical intervention.

Evaluation of a Hydrogel Liquid Embolic Agent in a Porcine Mesenteric Hemorrhage Model

PurposeTo evaluate the ability to achieve hemostasis of a new liquid embolic agent in a porcine mesenteric artery hemorrhage model. Materials and MethodsAn anticoagulated porcine mesenteric artery hemorrhage model was created using a transarterial approach. Arterial hemorrhage was the result of aspiration needle punctures and simultaneous radiofrequency current application. Ten injured mesenteric arteries in 8 swine were treated. The hydrogel liquid embolic agent under investigation, an aqueous-based and in situ polymerizing liquid embolic agent, was used to treat actively bleeding sites. At 7 days, confirmation angiography was performed, followed by necropsy. ResultsThe mesenteric arterial injuries produced persistent and angiographically visible hemorrhage before initiating embolic therapy. Arteriovenous fistulae were observed in 4 cases. Embolization led to hemostasis in 10 of the 10 bleeds (100%). The mean embolic agent delivery time was 5.3 minutes (range, 1–15 minutes) with a mean embolic agent volume of 2.9 mL (range, 0.8–5.2 mL) delivered to achieve hemostasis. Notably, 40% of the treatments embolized the injury in the artery at the treatment site while leaving the native arterial lumen patent for the 7-day term of survival. All animals survived with no clinical evidence of hemorrhage through 7 days. Necropsy did not reveal evidence of ischemia within the bowel, liver, or lung. ConclusionsA new hydrogel liquid embolic agent was found to achieve rapid and durable hemostasis in an animal model of acute mesenteric hemorrhage.

Successful conservative management of a large traumatic mesenteric hematoma: A case report.

Introduction and importanceIn blunt abdominal trauma, small bowel and mesentery injury (SBMI) is the third most common organ injury with an estimated incidence of 1–5%. Traumatic mesenteric injuries are difficult to diagnose and their undiagnosed complications are severe with high mortality rates.Case presentationA 21-year-old male presented to the emergency room with severe colicky pain in the right-hypochondrium 2 h after dinner. He gave history of nausea, vomiting and diarrhea after dinner and before the pain started. The morning after admission, a Contrast Enhanced Computed Tomography (CECT) scan was done which showed a large mesenteric hematoma. On subsequent questioning, the patient then recalled a blow to the abdomen while playing basketball two days ago. Since the patient was hemodynamically stable, non-operative management (NOM) was chosen with close monitoring. Regular follow-up ultrasonography (USG) scans showed progressive spontaneous resolution of the hematoma.Clinical discussionNonspecific symptoms of mesenteric hematoma make it difficult to reach a diagnosis. It is usually identified by history or medical imaging. Mesenteric hematoma can be managed conservatively if there is no active bleeding. In stable patients, selective visceral angiography should be performed and bleeding vessels should be embolized where possible.ConclusionThis case highlights a successful conservative management of a large traumatic mesenteric hematoma. It also emphasizes the importance of eliciting a detailed history of major or minor trauma for any patient with abdominal pain. Previous cases have also highlighted the importance of non-operative management and avoidance of emergency laparotomy in stable patients.

Angioembolization of Renal Artery Pseudoaneurysm in Blunt Trauma Abdomen

Pseudoaneurysm of the renal artery is a presentation of blunt abdominal injury. We present the case of a 40-year-old male with a history of road traffic accident with a complaint of severe abdominal pain and distention of the abdomen. Contrast-enhanced computed tomography (CECT) shows large perinephric hematoma with free fluid in the abdomen. He was treated conservatively for 48 h but having persistence hypotension with increase free fluids in the abdomen, so mesenteric injury and bowel ischemia was suspected and laparotomy performed and found retroperitoneal hematoma and rest are normal. After that he had persistent hematuria with shock. Repeat CECT showed large pseudoaneurysm of the right renal artery with extravasation of contrast with clot in the bladder. In view this condition, renal artery angioembolization was done.

The study on the role of laparoscopy in the blunt abdominal trauma: a case series

The blunt trauma to the abdomen is the leading cause of mortality and morbidity in India and also worldwide. The young and productive age group are the main victims. The common causes of blunt injury to the abdomen are road traffic accidents, assault, fall from height and work-related injuries. Abdominal trauma is present in 7-10% of all trauma victims and in cases of severe trauma, it is often associated with orthopedic, thoracic or central nervous system injuries. Identification of serious intra-abdominal injuries is often challenging. Thus, a rapid and accurate diagnosis is mandatory. The diagnostic laparoscopy has gained widespread acceptance as a valuable tool for the diagnosis and management of patients with blunt abdominal trauma. When the imaging techniques fail to give the precise diagnosis, diagnostic laparoscopy is a viable alternative for the management of such trauma. This case series consisted of 22 patients admitted to our institute. All the patients underwent diagnostic laparoscopy. The blunt trauma managed by laparoscopy while 12 patients required conversion to exploratory laparotomy. It was observed that the most common organ injured was spleen in 10 patients (45.4%), liver in 9 patients (40.9%), mesenteric injury in 4 patients (18.1%) and small bowel injury in 3 patients (13.6%) respectively. Diagnostic and therapeutic laparoscopy is a preferred in hemodynamically stable patients, it reduces the hospital stay and postoperative complications. This case series underlines the importance of diagnostic and therapeutic application of laparoscopy in the victims of blunt injury abdomen.

Leriche syndrome diagnosed due to polytrauma: a case report

BackgroundLeriche syndrome is caused by atherosclerosis and is often characterized by symptoms such as intermittent claudication and numbness and coldness of the lower limbs. Its exact prevalence and incidence are unknown because it is a rare disease. We report a case of Leriche syndrome diagnosed incidentally on trauma pan-scan computed tomography (CT).Case presentationA 61-year-old Asian male was driving a passenger car and had a head-on collision with a dump truck that required an emergency call. The patient was transported to our hospital in a doctor’s helicopter. Physical examination revealed the following vital signs: respiratory rate, 23 breaths per min; SpO2, 98% under a 10-L administration mask; pulse rate, 133 beats per min; blood pressure, 142/128 mmHg; Focused Assessment with Sonography for Trauma, positive; Glasgow Coma Scale assessment, E3V5M6; and body temperature, 35.9 °C.Trauma pan-scan CT showed bilateral mandibular fractures, bilateral multiple rib fractures, bilateral pneumothorax, sternal fractures, hematoma around thoracic spine, small bowel perforation, mesenteric injury, right clavicle fracture, right ankle debridement injury, and thrombotic occlusion from just above the abdominal aortic bifurcation to the bilateral common iliac arteries. Although thrombotic occlusion needed to be differentiated from traumatic aortic injury, the presence of collateral blood vessels led to the diagnosis of Leriche syndrome, and conservative treatment was performed.Damage control surgery was required for the small bowel injuries. From the second day of admission, the patient was treated with continuous intravenous heparin and prostaglandin preparations. However, impaired blood flow and reperfusion injury in the right lower extremity progressed. On the fifth day of admission, right thigh amputation was performed. The patient required renal replacement therapy for 2 weeks starting from the third day of admission.ConclusionsIn this case, conservative therapy was initially chosen for Leriche syndrome. However, the complex factors in the acute phase of trauma led to development of hemorrhagic necrosis, requiring amputation of the lower extremity. Our findings indicate the need to carefully consider the unique factors affecting Leriche syndrome patients when considering treatment indications and choices for trauma.

H12‐(ADP)‐liposomes for hemorrhagic shock in thrombocytopenia: Mesenteric artery injury model in rabbits

BackgroundDamage control resuscitation improves patient outcomes after severe hemorrhage and coagulopathy. However, effective hemostasis methods for these critical situations are lacking. ObjectiveWe evaluated the hemostatic efficacy of fibrinogen γ‐chain (HHLGGAKQAGDV, H12)‐coated, adenosine‐diphosphate (ADP)‐encapsulated liposomes (H12‐[ADP]‐liposomes) in thrombocytopenic rabbits with hemorrhagic shock. MethodsAcute thrombocytopenia (80%) was induced in rabbits that also received mesenteric vessel injury, leading to hemorrhagic shock. Five minutes after injury, subjects received intravenous bolus injection with H12‐(ADP)‐liposomes (20 mg/kg), followed by isovolemic transfusion with stored red blood cells (RBCs)/platelet poor plasma (PPP) (RBC:PPP = 1:1 [vol/vol]), or lactated Ringer solution every 5 min to compensate blood loss. One group received H12‐(phosphate buffered saline [PBS]) liposomes followed by RBC/PPP. Additional groups were received isovolemic transfusion with RBC/platelet rich plasma (PRP) (RBC:PRP = 1:1 [vol/vol]), RBC/PPP, PPP alone, or lactated Ringer solution. ResultsTreatment with H12‐(ADP)‐liposomes followed by RBC/PPP transfusion and RBC/PRP transfusion effectively stopped bleeding in all thrombocytopenic rabbits. In contrast, three of 10 rabbits treated with RBC/PPP failed hemostasis, and no rabbits receiving lactated Ringer solution stopped bleeding or survived. Twenty‐four hours after hemorrhage, 80% of rabbits receiving H12‐(ADP)‐liposome followed by RBC/PPP transfusion survived and 70% of rabbits receiving RBC/PRP transfusion also survived, although RBC/PPP‐transfused rabbits showed 40% survival. Rabbits receiving H12‐(ADP)‐liposomes followed by lactated Ringer solution showed a transient hemostatic potential but failed to survive. H12‐(PBS)‐liposomes showed no beneficial effect on hemostasis. Neither the PPP group nor the lactated Ringer group survived. ConclusionH12‐(ADP)‐liposome treatment followed by RBC/PPP may be effective in lethal hemorrhage after mesenteric vessel injury in coagulopathic rabbits.

Ten-year experience with laparoscopic pedicled omental flap for cerebral revascularization in patients with Moyamoya disease

BackgroundThe omental flap has numerous extraperitoneal applications in reconstruction and revascularization given its favorable immunologic and angiogenic properties. In patients with Moyamoya disease, cerebral revascularization using a pedicled omental flap has proven to be a viable option following direct revascularization procedures. Historically, harvesting omentum involved laparotomy with the associated risk of complications; herein we describe outcomes from a 10-year experience of laparoscopic harvesting of pedicled omental flap for cerebral revascularization in Moyamoya patients. MethodsA retrospective chart review was performed of all patients with Moyamoya disease who underwent laparoscopic omental cerebral transposition between 2011 and 2021. Intraoperative and postoperative complications, length of stay (LOS), and outcomes at follow-up were analyzed. ResultsTwenty-one patients underwent the procedure during the study period. Three intraoperative complications occurred (one segmental transverse colectomy for mesenteric injury, one converted to omental free flap, and one requiring micro anastomosis). Average overall LOS was 6 ± 6 days, with 3 ± 3.5 days in the ICU (mean±SD). Following discharge, complications included epigastric incisional hernia at the graft fascial exit site, recurrent neck pain at subcutaneous tunneling site, and partial scalp necrosis. One patient required subsequent direct bypass seven months after the initial procedure owing to the progression of the disease. All other patients had partial or complete resolution of symptoms. ConclusionOur retrospective observational study indicates that laparoscopic pedicled omental flap mobilization and transposition is a safe and effective method of indirect cerebral revascularization in patients with Moyamoya disease. Level of evidenceN/A.

A STUDY ON PATTERN OF BLUNT ABDOMINAL TRAUMA AND ITS OUTCOME FOLLOWING NON OPERATIVE MANAGEMENT

INTRODUCTION: Abdomen is the third most commonly injured part of the body following injuries to extremities and head. Blunt injury remains to be the most prevailing mode of abdominal injury. Motor vehicle accidents are the most common mode to cause Blunt abdominal trauma. Evolving imaging modalities like FAST, CT scans have resulted in signicant shift from surgical to more selective conservative management of blunt injury abdomen. MATERIALS AND METHODS: This is a prospective study of selected cases of Blunt injury abdomen managed in the Department of General Surgery in Rajah Muthiah Medical College and Hospital (RMMCH) during the period from September 2019 to October 2021. AIMS AND OBJECTIVES: The current study establishes the incidence and demographic distribution of patients who have sustained blunt abdominal trauma, also gives an outline which type of patient will benet conservative management and detects downfalls of surgical and conservative management and identies the causes of failure of Non operative management following blunt injury abdomen. RESULTS: In our study males were more commonly affected than females in the ratio 4:1 and age group involved ranging from 4 years to 69 years, majority were in second, third, fourth decades taking a toll of 71.25% of patients. The common presentations in these victims were abdominal pain, tenderness, diffuse guarding, rigidity, abdominal distention, sluggish/ absent bowel sounds, pallor, hypotension with features of shock. In unstable patients to detect hemoperitoneum, ultrasonography/FAST was a very helpful mode of investigation. But, it missed 3 cases with kidney injury, 5 cases with liver injury, and 9 cases with splenic injury. It is not an imaging of choice to detect bowel, kidney, pancreas and mesenteric injuries. CECT abdomen is the investigation of choice to grade the organ injuries. 37 patients with splenic injuries were identied by CT abdomen, of which 29 were managed conservatively. CT abdomen detected liver injuries in 21 patients, of which 16 were managed conservatively. Kidney injures were picked up in 5 patients with help of CT abdomen and all were subjected to conservative management. MANAGEMENT: From a total of 100 patients studied, 64 patients were selected for conservative management after initial resuscitation. Most common organ to get involved following Blunt abdominal trauma is Spleen (37%), followed by liver (21%), mesentery, small bowel and bladder. Out of 37 patients with splenic injuires, 29 were managed conservatively. 16 cases with isolated hepatic injury, 5 cases with kidney injury, 2 cases with bladder injury, 2 patients with mesenteric injury and one patient with pancreatic injury were managed conservatively. Morbidity and mortality: Mortality was not observed in patients subjected to conservative management. A total of 4 cases died in the operative group. Two patients due to pancreatic head transection, one due to associated head injury, one due to delayed hospitalization. The duration of hospitalization in patients who were managed conservatively ranged from 9-11 days and 14-20 days in patients who underwent surgery. One patient developed pseudocyst of pancreas following pancreatic injury and another patient developed clot retention following conservative management for bladder injury. The causes of failure of non operative management in patients with blunt abdominal trauma were patients with pancreatic head transection, ongoing hemorrhage/ features of peritonitis with hemoperitoneum and hollow viscus perforation. CONCLUSION: The success rates following conservative management of solid organ injures after blunt injury abdomen have been increasing and it is quite challenging also, since it requires close observation by experienced surgeon and there is a narrow line to choose the line of management (conservative / surgical) for better outcome. Involvement of multiple intra abdominal organs, other associated extra abdominal injuries, coexisting comorbid diseases and late presentation following injury increases the morbidity and mortality. Ultimately early diagnosis, aggressive adequate resuscitation and timely surgical intervention when needed in severely injured patients may boost the outcome in these patients who have failed conservative management.

Mesenteric Injury in Blunt Abdominal Trauma in Children: Is Early Surgical Intervention Need of the Hour?

Objective:There is an increasing trend of observational, nonsurgical management of abdominal injuries in children. We analyzed the feasibility and outcome of our management protocol in managing cases of the mesenteric injuries in blunt trauma abdomen in pediatric age group.Methods:Single-center retrospective analysis of pediatric trauma case records from July 2018 to March 2020 was performed.Results:Thirty-four cases of blunt abdominal trauma of whom 13 had mesenteric injuries were reviewed. The male-to-female ratio was 2.2:1, and the mean age was 9.11 ± 4.90 years. Mesentery of the small bowel was the most commonly injured segment and treatment consisted of repair of mesenteric tear, resection, and anastomosis with or without stoma formation.Conclusions:Isolated mesenteric injury of all grades should be managed either with diagnostic laparoscopy or laparotomy irrespective of hemodynamic status.

A case of superior mesenteric vein injury treated with ligation

A case of superior mesenteric vein injury treated with ligation

A Case of Traumatic Sigmoid Mesenteric Injury Associated with Hemophilia for which Appropriate Coagulation Factor Replacement was Effective

A Case of Traumatic Sigmoid Mesenteric Injury Associated with Hemophilia for which Appropriate Coagulation Factor Replacement was Effective

Missed abdominal injury: why and how to deal? A retrospective interventional study

Introduction: Literature is silent on missed abdominal surgery mostly because, it has become rare after the use of routine whole body CT scan. Even if missed, it remains so small a number and for fear of negative publicity, it goes unpublished. It is felt that, missing an abdominal injury must be having an altered final outcome on the patients. With this question in mind, the old data, kept prospectively was analysed, with an aim to find out the prevalence of missed abdominal injury, why were the injures were missed and how to deal with them early and effectively so as to have a possible positive change in the final outcome. Materials and methods: It was a retrospective interventional study from Jan 2002 to May 2017, where cases of blunt abdominal injuries were included and war/ insurgency related gunshot, penetrating and bowel injuries were excluded in two large military hospital in peace locations. Only cases with blunt injuries including the transferred patients from the other hospital were included in the study, where the injuries were missed at three level, namely clinically unsuspected, at CT scan and at laparotomy. Result: There were 72 patients with blunt abdominal injuries. There were 67 males and five females with age range from 8- 72 years (mean 30.70 SD13.759).Forty-three (43) patients were managed by observation and 18 patients were operated. Twelve (12) injuries were missed mostly due to, not suspecting an injury, un-conscious patient with severe head injury and misinterpretation of CT images. Six patients underwent laparoscopy. Only one patient, a laparotomy was avoided. There were three mortalities from the missed organ injury group. Conclusion: Missing an injury is presumed to be relatively uncommon. Mesenteric and isolated pancreatic injury are most often missed. Diagnostic laparoscopy confirms mesenteric injury and saponification of fat suggest pancreatic injury and duodenal injury even missed at laparotomy, when done very early.

Use of near-infrared imaging using indocyanine green associates with the lower incidence of postoperative complications for intestinal and mesenteric injury

Anastomotic leakage after intestinal resection is one of the most serious complications of surgical intervention for hollow viscus injury. Adequate vascular perfusion of the anastomotic site is essential to prevent anastomotic leakage. Near-infrared imaging using indocyanine green (NIR-ICG) is useful for the objective assessment of vascular perfusion. The aim of this study was to evaluate the association of NIR-ICG with intestinal and mesenteric injuries. This was a retrospective, single-center study of patients undergoing surgery for intestinal and mesenteric injuries. NIR-ICG was used to evaluate vascular perfusion. Postoperative complications were assessed between NIR-ICG and non-NIR-ICG groups.The use of NIR-ICG was associated with a lower incidence of Clavien-Dindo grade ≥ III complications with a statistical tendency (p = 0.076). When limited to patients that underwent intestinal resection, the use of NIR-ICG was significantly associated with a lower risk of perioperative complications (p = 0.009). The use of NIR-ICG tended to associate with the lower incidence of postoperative complications after intestinal and mesenteric trauma surgery. NIR-ICG was associated with a significantly lower risk of complications in patients undergoing intestinal resection. The NIR-ICG procedure is simple and quick and is expected to be useful for intestinal and mesenteric trauma.

The Current Diagnostic Accuracy on Free Peritoneal Fluid in Computed Tomography to Determinate the Necessity of Surgery in Blunt Bowel and Mesenteric Trauma-Systemic Review and Meta-Analysis.

Traumatic bowel mesenteric injury (TBMI) is a challenge in trauma care. The presence of free peritoneal fluid (FF) in computed tomography (CT) was considered the indication for surgical intervention. However, conservative treatment should be applied for minor injuries. We conduct a systematic review to analyze how reliable the FF is to assess the TBMI. Publications were retrieved by structured searching among databases, review articles and major textbooks. For statistical analysis, summary receiver operating characteristic curves (SROCs) were computed using hierarchical models. Fourteen studies enrolling 4336 patients were eligible for final qualitative analysis. The SROC line was created by a hierarchical summary receiver operating characteristic model. The summary sensitivity of FF to predict surgical TBMI was 0.793 (95% CI: 0.635–0.894), and the summary specificity of FF to predict surgical TBMI was 0.733 (95% CI: 0.468–0.896). The diagnostic odds ratio was 10.531 (95% CI: 5.556–19.961). This study represents the most robust evidence (level 3a) to date that FF is not the absolute but an acceptable indicator for surgically important TBMI. However, there is still a need for randomized controlled trials to confirm.

シートベルトにより生じた鈍的腹部大動脈損傷の2例(Prevalent sites and conditions of blunt abdominal aortic injury caused by seat belt: Case series)

要旨 シートベルトによる鈍的腹部大動脈損傷（BAAI）は死亡率が高く，また，見逃されやすい。今回，シートベルトにより生じたと考えられるBAAIを2例経験した。症例1：30才男性，ガードレールに衝突し受傷した。シートベルト痕，腸間膜損傷，第2腰椎骨折，BAAIを認め，腸間膜損傷に対し開腹止血術を施行，BAAIについては第9病日にステントグラフト内挿術を施行した。症例2：77才女性，ガードレールに衝突し受傷した。シートベルト痕，肝損傷，膵損傷，小腸損傷，腰椎骨折，BAAIを認めた。ガーゼパッキングと小腸穿孔部の縫合を行い，BAAIは保存的に管理した。いずれの症例もCTでシートベルト痕と思われる皮下組織の濃度上昇，腹腔内臓器損傷，腰椎骨折を認め，ともに第2/3腰椎椎間板高位でのBAAIを認めた。シートベルト痕，腸管・腸間膜損傷，腰椎骨折を3徴とするシートベルト症候群ではBAAIを考慮した画像評価を行う必要があること，シートベルトによるBAAIは第2–3腰椎高位が好発部位であることが示唆された。

Forensic medical evaluation of an isolated injury of the small bowel mesentery and its vessels (literature review extended with expert case report)

This work summarizes information from the modern scientific literature devoted to the issues of morphology and mechanisms of an isolated mesenteric injury, which is rare in expert practice. Apart from classic forensic medical papers, publications over 2000 – 2020, devoted to abdominal organ injuries, were analyzed. In the search engines PUBMED and eLibrary.ru, a selection of sources was made according to the keywords: “rupture of the mesenteric root of the small intestine,” “diagnostics,” “forensic medical evaluation.” The results of the literature analysis were used in the study of the repeated forensic medical examination materials of a case of rapid death (in 1.5 hours) due to a traumatic rupture of the mesentery of the small bowel and its large vessels. The combined analysis of the expert case report and special scientific literature allows us to devise the following conclusions: 1. A forensic expert must have expert knowledge in the normal anatomy of the abdominal aorta’s unpaired vessels and their accompanying veins location and know about their variable topographic and anatomical features. 2. Life-threatening bleeding from the damaged vessel of the mesentery of the small bowel occurs in a wide time interval after the mechanical damage. 3. The development of life-threatening intra-abdominal bleeding is due to the scope of damage and the rate of blood flow from the damaged vessel. 4. Thorough examination of the area of rupture of the mesenteric vessel and the state of the tissues in the circumference of the rupture allow to establish the mechanism of injury. 5. Ignorance of the mechanism of injury and specifics of the formation of injuries is the cause of expert errors and scientifically unfounded conclusions. 6. There is no reference material on the rate of blood flow from a damaged large vessel.

Superior Mesenteric Artery and Vein Injuries: Operative Strategies and Outcomes.

Traumatic injuries to the mesenteric vessels are rare and often lethal. Visceral vessels, such as the superior mesenteric artery (SMA) and vein (SMV), supply blood to the small and large bowel by a rich system of collaterals. Because fewer than 100 such injuries have been described in the literature, they pose challenges in both diagnosis and management and can unfortunately result in high mortality rates. Prompt diagnosis, surgical intervention, and resuscitation can lead to improved outcomes. Here, we review the literature surrounding traumatic injuries of the SMA/SMV and discuss management strategies.