Blunt abdominal trauma and mesenteric avulsion: a systematic review

Area of Science:

• Trauma Surgery
• Abdominal Imaging
• Surgical Pathology

Background:

• Mesenteric avulsions are uncommon but severe injuries resulting from blunt abdominal trauma.
• Their presentation can be vague, making diagnosis challenging for emergency physicians.

Purpose of the Study:

• To elucidate the biomechanics, clinical presentation, and diagnostic approaches for mesenteric avulsions.
• To establish a consensus on the optimal management strategies for these injuries.

Main Methods:

• A systematic literature review was conducted across major medical databases (MedLine, Embase, Scopus, CINAHL) from 1951 to November 2014.
• Twenty reported cases were analyzed for patient demographics, injury mechanisms, clinical signs, diagnostic modalities, treatment, and outcomes.

Main Results:

• The median age of affected patients was 28.5 years, with a 3:1 male-to-female ratio.
• Road traffic accidents, particularly those involving seat belt restraint, were the most common cause (60%).
• Diffuse abdominal tenderness (45%) and bruising (40%) were the most frequent presentations; CT scans were the preferred diagnostic tool (45%).
• Ninety percent of patients underwent emergency exploratory laparotomy within 24 hours, with a median hospital stay of 19 days and a 15% mortality rate.

Conclusions:

• Mesenteric avulsion is a rare condition with complex and often non-specific symptoms.
• A high index of suspicion is essential for emergency physicians managing blunt abdominal trauma, regardless of the injury mechanism, to mitigate potential mortality and morbidity.