Abdominal bleeding secondary to isolated mesenteric injury following blunt abdominal trauma: A case report.

Abstract

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.