Accidental Blunt Abdominal Injury Causing Multiple Small Bowel Loops’ Avulsion from the Mesentery and Dismembered Colon

A 50-year-old male, truck driver, met with an accident with blunt steering wheel injury to the abdomen with no external marks ofinjury over the abdominal wall. He had severe abdominal pain with tossing up in bed. As the abdomen showed no external marksof injuries, strikingly, abdominal palpatory findings were prominent with severe tenderness in the left side umbilical and pelvicregions. He had consumed heavy food with liquids within an hour before the accident. He collided with another stationary lorry;thus, he received massive blow to his abdomen with the steering wheel. He displayed the signs of hemorrhagic shock on arrivalto the emergency care. Computed tomography scan confirmed moderate hemoperitoneum with multiple bowel perforations. Onexploratory laparotomy, multiple jejunal and ileal loops were found completely avulsed from the base of the mesentery, makingthem completely devascularized along with dismembered descending colon from the sigmoid. Resection of nonviable smallbowels and end-to-end jejunoileal anastomosis was done. Colocolic anastomosis was performed after adequate descendingcolon mobilization with protective loop ileostomy in the right lower quadrant. The patient had developed wound infection; hence,he was put on daily dressing. Gradually, the patient improved and was discharged with functioning ileostomy.

Death due to isolated mesenteric vascular injury following blunt abdominal trauma: A case report.

Death due to isolated injury to small bowel mesentery following abdominal trauma is rare. It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. Focal mesenteric infiltration associated with haemoperitoneum, particularly in the absence of solid organ injury, is highly suggestive of a mesenteric tear. In this report one such seat belt abdominal injury with subsequent mesenteric tear and bowel infarction with significant haemoperitoneum leading to death on the Operation table is being discussed. The main significance of this injury is delay and difficulty in diagnosis, especially when there is minimal signs and symptoms to warrant an exploratory laparotomy. Early detection and emergency surgical intervention when necessary are critical in improving the outcome of treatment.