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.