Isolated mesocolon injury and sigmoid colon necrosis secondary to abdominal blunt trauma

Abstract

Introduction

Blunt abdominal trauma from road traffic crashes can lead to a range of injuries, including those to the mesocolon. While solid organ injuries are common, mesocolon injuries resulting in bowel necrosis are rare but potentially life-threatening. This case report describes a 47-year-old male involved in a high-impact road traffic crash, who developed mesocolon injury with subsequent bowel necrosis.

Case presentation

A 47-year-old male, a drunk driver, was admitted following a high-impact road traffic crash. Initial examination revealed hemodynamic instability and significant abdominal tenderness. A contrast-enhanced CT scan showed hemoperitoneum and signs of mesenteric injury. Surgery revealed generalized hemoperitoneum with blood clots and a ruptured sigmoid mesocolon, resulting in necrosis of approximately 20 cm of bowel. The patient underwent Hartmann's procedure, and his postoperative recovery was uneventful.

Discussion

Mesocolon injuries are rare, accounting for 1–5 % of blunt abdominal trauma cases. Symptoms often overlap with other abdominal pathologies, complicating diagnosis. Imaging, especially CT, is crucial in identifying the extent of injury. Surgical intervention is required for cases involving bowel necrosis, with Hartmann's procedure being the treatment of choice. Early diagnosis and prompt surgical management are critical for favorable outcomes.

Conclusion

This case highlights the importance of considering mesocolon injuries in trauma patients, especially in the context of abdominal tenderness and hemodynamic instability. Timely imaging and surgical intervention are essential for managing these rare but serious injuries.