AN ISOLATED MESENTERIC INJURY DUE TO BLUNT TRAUMA ABDOMEN CAUSINGGANGRENE OF SMALL BOWEL

Abstract

Hollow viscous injury and mesenteric vascular injury after a blunt trauma abdomen although may be third most common injury , occurs only in 3 to 5 % of patients making it a rare entity. Significant mesentric injury includes disruption of mesenteric, active mesenteric bleeding, and mesenteric injury leading to gangrenous bowel.A 56 year old male was brought to the emergency room with history of road traffic accident with no external injuries.On presentation his vitals were stable , examination of abdomen revealed tense abdomen with guarding and rigidity. Given the hemodynamic stability of the patient CT scan of abdomen was done which revealed intraperitoneal free fluid , normal solid organs, abnormal bowel wall enhancement with extraluminal air pockets.Patient underwent emergency laparotomy to find out a massive hemoperitoneum with long segment gangrenous illeal bowel loop. Gangrenous bowel segment was resected and double barrel ileostomy was fashioned. The mechanism of injury involved is either direct compression forces or shearing and deceleration forces in Blunt trauma abdomen.Undiagnosed mesenteric injuries are associated with high morbidity and mortality rates due to life-threatening haemorrhage from disruption of mesenteric vessels, bowel infarction and peritonitis . This can be avoided by using imaging investigations af earliest and emergency surgical intervention.