Surgically confirmed mesenteric avulsion following blunt abdominal trauma: a contemporary case series

To summarize the clinical, radiologic, and surgical characteristics of the rare but potentially fatal cases of mesenteric avulsion (MA) following blunt abdominal trauma, based on our single-center experience, and to highlight key implications for early diagnosis and management.

Consecutive patients who underwent surgery between January 2017 and September 2025 and were intraoperatively confirmed to have MA were retrospectively reviewed. Demographic data, mechanism of injury, CT findings, involved intestinal segments, surgical procedures, intensive care and hospital stay, complications, and mortality were recorded. Results were analyzed descriptively.

A total of 13 patients (mean age, 44.5 years (20-83) were included. The most common mechanism of trauma was motor vehicle collision (69.2%). No patient showed direct CT evidence of MA (0%); all exhibited only nonspecific findings such as free fluid, solid-organ injury, or mesenteric hematoma (100%). Intraoperative involvement included jejunal (30.8%), ileal (38.5%), colonic (15.4%), and multisegmental (15.4%) regions. Segmental resection with primary anastomosis was performed in 69.2% of patients, stoma formation in 15.4%, and damage-control surgery (diagnostic laparotomy + packing) in 15.4%. The mean ICU stay was 3.1 days, and total hospital stay was 11.2 days. Postoperative complications occurred in 30.7% and resolved with conservative treatment. Four patients (30.7%) died, primarily due to concomitant multisystem or severe cranial/thoracic trauma.

In MA cases, preoperative CT typically demonstrates nonspecific findings, making prospective diagnosis difficult. Maintaining a low threshold for early surgical exploration in the presence of hemodynamic instability, peritonitis, or a high index of clinical suspicion is essential to preserve bowel viability and reduce morbidity and mortality. Our study demonstrates that jejunal-ileal predominance, frequent use of resection with primary anastomosis, and the impact of associated multiple injuries are the major determinants of outcomes. Sustaining clinical vigilance and prompt surgical decision-making remain key to improving patient survival. Our findings emphasize that mesenteric avulsion remains largely a clinical and intraoperative diagnosis, and early surgical exploration should not be delayed based on negative or nonspecific CT findings.