Mesenteric Shearing in a Pediatric Patient, Successfully Managed Conservatively: A Case Report.

Abstract

Mesenteric shear, injury due to sudden stretch of the mesentery, is a rare condition that remains poorly studied, especially in the pediatric population. Often resulting from trauma, its presentation can vary from nonspecific and vague abdominal symptoms to an acute abdomen and peritonitis requiring urgent surgical intervention. Unified management strategies are not yet in place. We describe the case of a 10-year-old boy who presented to the emergency department with diffuse abdominal pain of 1 day duration, 2 days after he sustained blunt abdominal trauma with an elbow during a soccer match. He was hemodynamically and clinically stable. Computed tomography scan revealed soft tissue thickening in the left upper quadrant at the root of the mesentery with mild surrounding inflammatory mesenteric fat stranding, suggesting mesenteric shearing. With stable vitals, a soft abdomen on physical exam, and no drop in hemoglobin, the decision was made to treat the patient conservatively. The patient was admitted for observation, and after frequent abdominal exams, stable laboratory results, and abdominal imaging, he was discharged home without any surgical intervention. Conservative management can be successful in the case of a stable patient without alarming physical, laboratory, or imaging findings. Observation and close monitoring remain essential to detect complicated cases that require surgical intervention.