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25.03.2015 | Review Article

Blunt abdominal trauma and mesenteric avulsion: a systematic review

verfasst von: A. Kordzadeh, V. Melchionda, K. M. Rhodes, E. O. Fletcher, Y. P. Panayiotopolous

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 3/2016

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Abstract

Purpose

The aim of this study is to establish the biomechanics, presentation and diagnosis of mesenteric avulsions following blunt abdominal trauma and reach a consensus on their overall management.

Materials and methods

A systematic review of literature in MedLine, Embase, Scopus and CINHAL in English language from 1951 to November 2014 was performed. A total of 20 reported cases were identified. Variables including patient’s demographics, signs and symptoms, mechanism of injury, investigative modality, management, length of stay, follow-up and outcomes were reviewed and analyzed.

Results

The median age of the cohort was 28.5 years (range 10–58 years), with a male-to-female ratio of 3:1. The commonest mechanism of injury was road traffic accident due to seat belt restraint (n = 12, 60 %). The commonest presentation was diffuse abdominal tenderness (n = 10, 45 %) followed by ecchymosis/bruising (n = 9, 40 %). Computed tomography (CT) remained the investigative modality of choice (n = 9, 45 %). All cases had an emergency exploratory laparotomy (n = 18, 90 %) within the initial 24 h and the median length of stay was 19 days (range 4–90 days). The overall mortality was 15 % (n = 3).

Conclusion

Mesenteric avulsion is rare and has a complex and vague presentation. Due to its potential mortality and morbidity, emergency physicians should keep a high index of suspicion in individuals with blunt abdominal trauma from any mechanism of injury.
Literatur
1.
Zurück zum Zitat Hughes TM, Elton C. The pathophysiology and management of bowel and mesenteric injuries due to blunt trauma. Injury. 2002;33:295–302.CrossRefPubMed Hughes TM, Elton C. The pathophysiology and management of bowel and mesenteric injuries due to blunt trauma. Injury. 2002;33:295–302.CrossRefPubMed
2.
Zurück zum Zitat Murless BC. Transverse rupture of the mesentery, complicated by arterial embolism. BJS. 1942;30(117):84–6.CrossRef Murless BC. Transverse rupture of the mesentery, complicated by arterial embolism. BJS. 1942;30(117):84–6.CrossRef
3.
Zurück zum Zitat Talton DS, Craig MH, Houser CJ, et al. Major gastroenteric injuries from blunt abdominal trauma. Am Surg. 1995;61:69–73.PubMed Talton DS, Craig MH, Houser CJ, et al. Major gastroenteric injuries from blunt abdominal trauma. Am Surg. 1995;61:69–73.PubMed
4.
Zurück zum Zitat Anderson PA, Rivara FP, Maier RV, et al. The epidemiology of seat belt associated injuries. J Trauma. 1991;31:60–7.CrossRefPubMed Anderson PA, Rivara FP, Maier RV, et al. The epidemiology of seat belt associated injuries. J Trauma. 1991;31:60–7.CrossRefPubMed
5.
Zurück zum Zitat Gill IS, Toursarkissian B, Johnson SB, et al. Traumatic ventral abdominal hernia associated with small bowel gangrene. J Trauma. 1993;35:145–7.CrossRefPubMed Gill IS, Toursarkissian B, Johnson SB, et al. Traumatic ventral abdominal hernia associated with small bowel gangrene. J Trauma. 1993;35:145–7.CrossRefPubMed
6.
Zurück zum Zitat Nolan BW, Gabram SG, Schwartz RJ, et al. Mesenteric injury from blunt trauma. Am Surg. 1995;61:501–6.PubMed Nolan BW, Gabram SG, Schwartz RJ, et al. Mesenteric injury from blunt trauma. Am Surg. 1995;61:501–6.PubMed
7.
Zurück zum Zitat Kordzadeh A, Devanesan A, Parkinson T, et al. Subtle mesenteric avulsion in traumatic abdominal wall hernia: a case report. Int J Surg Case Rep. 2012;3(9):417–9.CrossRefPubMedPubMedCentral Kordzadeh A, Devanesan A, Parkinson T, et al. Subtle mesenteric avulsion in traumatic abdominal wall hernia: a case report. Int J Surg Case Rep. 2012;3(9):417–9.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Fakhry SM, Watts DD, Luchette FA. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel innjry: analysis from 275,557 trauma admissions from the EAST Multi-institutional HVI trial. J Trauma. 2003;54(295):06. Fakhry SM, Watts DD, Luchette FA. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel innjry: analysis from 275,557 trauma admissions from the EAST Multi-institutional HVI trial. J Trauma. 2003;54(295):06.
9.
Zurück zum Zitat Bege T, Mennard J, Tremblay J, et al. Biomechanical analysis of traumatic mesenteric avulsion. Med Biol Eng Comput 2014 [Epud ahead of print]. Bege T, Mennard J, Tremblay J, et al. Biomechanical analysis of traumatic mesenteric avulsion. Med Biol Eng Comput 2014 [Epud ahead of print].
10.
Zurück zum Zitat Aiken DW. Intestinal perforation and facial fracture in automobile accident victim wearing a seat belt. J La State Med Soc. 1963;115:235.PubMed Aiken DW. Intestinal perforation and facial fracture in automobile accident victim wearing a seat belt. J La State Med Soc. 1963;115:235.PubMed
11.
Zurück zum Zitat Frampton R, Lenard J, Campigne S. An in depth study of abdominal injuries sustained by a car occupants in frontal crashes. Ann Adv Automot Med. 2012;56:137–49.PubMedPubMedCentral Frampton R, Lenard J, Campigne S. An in depth study of abdominal injuries sustained by a car occupants in frontal crashes. Ann Adv Automot Med. 2012;56:137–49.PubMedPubMedCentral
12.
Zurück zum Zitat Spencer Netto FC, Hamilton P, Rizoli SB, et al. Abdominal wall hernia: epidemiology and clinical implications. J Trauma. 2006;61:1058–61.CrossRef Spencer Netto FC, Hamilton P, Rizoli SB, et al. Abdominal wall hernia: epidemiology and clinical implications. J Trauma. 2006;61:1058–61.CrossRef
13.
Zurück zum Zitat Brofman N, Atri M, Hanson JM, et al. Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics. 2006;26:1119–31.CrossRefPubMed Brofman N, Atri M, Hanson JM, et al. Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics. 2006;26:1119–31.CrossRefPubMed
14.
Zurück zum Zitat Sharma OP, Oswanski MF, Singer D, et al. The role of computed tomography in diagnosis of blunt intestinal and mesenteric trauma (BIMT). J Emerg Med. 2004;27(1):55–67.CrossRefPubMed Sharma OP, Oswanski MF, Singer D, et al. The role of computed tomography in diagnosis of blunt intestinal and mesenteric trauma (BIMT). J Emerg Med. 2004;27(1):55–67.CrossRefPubMed
15.
Zurück zum Zitat Camacho, M. Bowel and Mesenteric Injury. Conf. State of the Art Emergency & Trauma Radiology. American Roengten Ray Society. Washington D.C., 13-18 Apr. 2008. Camacho, M. Bowel and Mesenteric Injury. Conf. State of the Art Emergency & Trauma Radiology. American Roengten Ray Society. Washington D.C., 13-18 Apr. 2008.
16.
Zurück zum Zitat Pennington CJ, Gwaltney N, Sweizer D. Microvascular repair of jejunal and ileal vessels for near complete mesenteric avulsion after seat belt injury. J Trauma. 2000;48:327–9.CrossRefPubMed Pennington CJ, Gwaltney N, Sweizer D. Microvascular repair of jejunal and ileal vessels for near complete mesenteric avulsion after seat belt injury. J Trauma. 2000;48:327–9.CrossRefPubMed
17.
Zurück zum Zitat Hinckley HM, Albertson HA. Avulsion of mesentery with gangrene segment of small bowel (Ileum) following non penetrating trauma of abdomen. Ann Surg. 1954;140(2):257–9.CrossRefPubMedPubMedCentral Hinckley HM, Albertson HA. Avulsion of mesentery with gangrene segment of small bowel (Ileum) following non penetrating trauma of abdomen. Ann Surg. 1954;140(2):257–9.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Doersch KB, Dozier WE. The seat belt syndrome. The seat belt sign, intestinal and mesenteric injuries. Am J Surg. 1968;116(6):831–3.CrossRefPubMed Doersch KB, Dozier WE. The seat belt syndrome. The seat belt sign, intestinal and mesenteric injuries. Am J Surg. 1968;116(6):831–3.CrossRefPubMed
19.
Zurück zum Zitat Garfinkle SE, Matolo NM. Gastric necrosis from blunt abdominal trauma. J Trauma. 1976;16(5):405–7.CrossRefPubMed Garfinkle SE, Matolo NM. Gastric necrosis from blunt abdominal trauma. J Trauma. 1976;16(5):405–7.CrossRefPubMed
20.
Zurück zum Zitat Eriksson A. Homicidal blunt abdominal trauma with isolated laceration of small bowel mesentery. Z Rechtsmed. 1984;93(2):143–6.CrossRefPubMed Eriksson A. Homicidal blunt abdominal trauma with isolated laceration of small bowel mesentery. Z Rechtsmed. 1984;93(2):143–6.CrossRefPubMed
21.
Zurück zum Zitat Voiglio EJ, Boutillier du Retail C, Neidhardt JP, et al. Gastrocolic vein. Definition and report of two cases of avulsion. Surg Radiol Anat. 1998;20(3):197–201.PubMed Voiglio EJ, Boutillier du Retail C, Neidhardt JP, et al. Gastrocolic vein. Definition and report of two cases of avulsion. Surg Radiol Anat. 1998;20(3):197–201.PubMed
22.
Zurück zum Zitat Pennington CJ, Gwaltney N, Sweitzer D. Microvascular repair of jejunal and ileal vessels for near complete mesenteric avulsion after seat belt injury. J Trauma. 2000;48(2):327–9.CrossRefPubMed Pennington CJ, Gwaltney N, Sweitzer D. Microvascular repair of jejunal and ileal vessels for near complete mesenteric avulsion after seat belt injury. J Trauma. 2000;48(2):327–9.CrossRefPubMed
23.
Zurück zum Zitat Voellinger DC, Saddakni S, Melton SM, et al. Endovascular repair of a traumatic infrarenal aortic transection: a case report and review. Vasc Surg. 2001;35(5):385–9.CrossRefPubMed Voellinger DC, Saddakni S, Melton SM, et al. Endovascular repair of a traumatic infrarenal aortic transection: a case report and review. Vasc Surg. 2001;35(5):385–9.CrossRefPubMed
24.
Zurück zum Zitat Marti M, Pinilla I, Baudraxler F, Simon MJ, et al. A case of acute abdominal aortic dissection caused b y blunt trauma. Emerg Radiol. 2006;12(4):182–5.CrossRefPubMed Marti M, Pinilla I, Baudraxler F, Simon MJ, et al. A case of acute abdominal aortic dissection caused b y blunt trauma. Emerg Radiol. 2006;12(4):182–5.CrossRefPubMed
25.
Zurück zum Zitat Slobogean GP, Tredwell SJ, Masterson JS. Ureteropelvic junction disruption and distal ureter injury associated with a chance fracture following a traffic accident: a case report. I Ortho Surg. 2007;15(2):248–50. Slobogean GP, Tredwell SJ, Masterson JS. Ureteropelvic junction disruption and distal ureter injury associated with a chance fracture following a traffic accident: a case report. I Ortho Surg. 2007;15(2):248–50.
26.
Zurück zum Zitat Woo K, Margulies DR, Gaon MD, et al. Intracorporeal laparoscopic Management of mesenteric avulsion in a blunt trauma patient. J Truama. 2009;76(4):E104–7.CrossRef Woo K, Margulies DR, Gaon MD, et al. Intracorporeal laparoscopic Management of mesenteric avulsion in a blunt trauma patient. J Truama. 2009;76(4):E104–7.CrossRef
27.
Zurück zum Zitat Sall I, El Kaoui H, Bouchentouf SM, et al. Delayed repair for traumatic abdominal wall hernia: is it safe? Hernia. 2009;13(4):447–9.CrossRefPubMed Sall I, El Kaoui H, Bouchentouf SM, et al. Delayed repair for traumatic abdominal wall hernia: is it safe? Hernia. 2009;13(4):447–9.CrossRefPubMed
28.
Zurück zum Zitat Tonsi AF, Alkusheh M, Reddy K, et al. Bicycle handlebar hernia with multiple enterotomies: a case report. Acta Chir Belg. 2010;110(2):243–5.CrossRefPubMed Tonsi AF, Alkusheh M, Reddy K, et al. Bicycle handlebar hernia with multiple enterotomies: a case report. Acta Chir Belg. 2010;110(2):243–5.CrossRefPubMed
29.
Zurück zum Zitat Nosanov LB, Barthel ER, Pierce JR. Sigmoid perforation and bucket-handle tear of the mseocolon after bucyle handlebar injury: a case report and review of the literature. J Pediatr Surg. 2011;46(12):E33–5.CrossRefPubMed Nosanov LB, Barthel ER, Pierce JR. Sigmoid perforation and bucket-handle tear of the mseocolon after bucyle handlebar injury: a case report and review of the literature. J Pediatr Surg. 2011;46(12):E33–5.CrossRefPubMed
30.
Zurück zum Zitat Yilmaz KB, Akinci M, Kaya O, et al. Emergency surgery due to go-kart injuries: report of two consecutive cases. Ulus Travma Acil Cerrahi Derg. 2012;18(2):458–60.CrossRefPubMed Yilmaz KB, Akinci M, Kaya O, et al. Emergency surgery due to go-kart injuries: report of two consecutive cases. Ulus Travma Acil Cerrahi Derg. 2012;18(2):458–60.CrossRefPubMed
Metadaten
Titel
Blunt abdominal trauma and mesenteric avulsion: a systematic review
verfasst von
A. Kordzadeh
V. Melchionda
K. M. Rhodes
E. O. Fletcher
Y. P. Panayiotopolous
Publikationsdatum
25.03.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 3/2016
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-015-0514-z

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