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Updated: May 20, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Abdominal bleeding secondary to isolated mesenteric injury following blunt abdominal trauma: A case report
Zhiqiang Ming1, Chao Xiao2,3, Rui Xiao1
1Department of Radiology, Zigong First People's Hospital, Zigong, Sichuan Province, China.
Rationale:
Isolated mesenteric injury often results from traffic accidents causing blunt abdominal trauma, exhibit nonspecific symptoms and signs. Most mesenteric injuries occur concurrently with injuries to other organs, such as the liver and spleen. As a result, the incidence of isolated mesenteric injury is very low and often misdiagnosed.
Patient Concerns:
A 49-year-old male patient presented with abdominal pain following a traffic accident more than 5 hours before admission. Upon admission, his blood pressure was normal but dropped sharply in a short time and presented with shock. Anemia, abrasions in the upper abdomen, cold skin on the dorsum of the foot, rebound pain, muscle tension, and noncoagulation of abdominal blood were all observed during the physical examination. Emergency plain and contrast-enhanced abdominal computed tomography (CT), and mesenteric artery CT angiography revealed a large volume of blood accumulated in the abdomen, pelvis, and jejunal mesentery. The jejunal wall and mesentery were edematous, with mesenteric distortion, and some branches of the inner jejunal artery were not clearly visualized. We found no evidence of liver or splenic rupture.
Diagnoses:
Mesenteric injury of the jejunum caused acute hemorrhagic anemia and hemorrhagic shock.
Interventions:
An emergency laparotomy was performed.
Outcomes:
An emergency laparotomy showed 3 hematomas close to the perforation site, 2 fully split tears in the jejunal mesentery, bleeding from partially exposed veins, a significant amount of blood and clots in the abdominal cavity, and serosal damage at the jejunal mesentery's root. The patient recovered well after we performed abdominal cavity drainage and jejunal mesenteric hemostasis and repair.
Lessons:
Isolated mesenteric injuries are very rare in clinical practice, and their clinical symptoms and signs are nonspecific, which makes them prone to misdiagnosis and oversight. When a patient satisfies the 4 requirements listed below: abdominal hemorrhage or hematoma; a history of abdominal trauma; no damage to high-risk organs like the liver or spleen; the CT-detected signs of mesenteric injury. Abdominal paracentesis or laparoscopy should be conducted to confirm the diagnosis and initiate further treatment.
Insights
Isolated mesenteric injury is rare and often missed. Prompt diagnosis and surgical intervention are crucial for patients presenting with abdominal trauma and signs of internal bleeding.
Area of Science:
- Trauma Surgery
- Abdominal Imaging
- Gastrointestinal Surgery
Background:
- Isolated mesenteric injury is uncommon, frequently misdiagnosed due to non-specific symptoms.
- Blunt abdominal trauma from accidents is a common cause, often involving multiple organ injuries.
Purpose of the Study:
- To highlight the diagnostic challenges and management of isolated jejunal mesenteric injury.
- To emphasize the importance of timely diagnosis and intervention in blunt abdominal trauma.
Main Methods:
- Case report of a 49-year-old male with blunt abdominal trauma.
- Utilized physical examination, computed tomography (CT), and CT angiography for diagnosis.
- Emergency laparotomy for surgical intervention.
Main Results:
- Patient presented with hemorrhagic shock and anemia post-trauma.
- CT revealed significant intra-abdominal hemorrhage and mesenteric injury.
- Laparotomy confirmed jejunal mesenteric tears and hematomas; successful hemostasis and repair were performed.
Conclusions:
- Isolated mesenteric injuries require high clinical suspicion due to non-specific signs.
- A combination of clinical presentation, CT findings, and surgical exploration is key for diagnosis.
- Early surgical intervention is vital for favorable outcomes in mesenteric trauma.
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