Presentation
The patient presented to the ER as a case of polytrauma (frontal impact in road traffic accident). On examination, the abdomen was tender and rigid with absent bowel sounds, CBC and CT trauma protocol was requested.
Patient Data
CT study of the abdomen and pelvis with IV contrast shows a focal area of mesenteric infiltration (haziness and fat stranding) consistent with mesenteric hematoma, the distal small bowel shows segmental loss of the normal mural enhancement suggestive of bowel ischemia, moderate amount of pelvis-abdominal free fluid with minimal pneumoperitoneum. Hyperenhancing kidneys and slit-like IVC consistent with CT hypoperfusion complex.
Case Discussion
The patient was reported to have emergent findings upon which the surgical team was called and the patient was shifted to the OR with all these findings confirmed and operated by resection and anastomosis of the ischemic segment, repairing the mesentery and closed over surgical drains.
Mesenteric injury with or without bowel injury is an emergency that should be immediately reported to the surgical team as the patient either should be transferred to the OR or should be closely observed.
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