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Bowel and mesenteric trauma

Dr Ammar Haouimi and Dr Henry Knipe et al.

Bowel and mesenteric trauma can result from blunt force, penetrating and iatrogenic trauma.

The bowel and mesentery are injured in ~2.5% (range 0.3-5%) of blunt force abdominal trauma 1,3,5,8. However not surprisingly, bowel and mesenteric injuries are more frequent after penetrating trauma 8. Bowel injury has consistently been found to be the most common traumatic abdominopelvic injury missed on CT 11.

Gunshot wounds (~75%) and stabbings (~20%) are the leading causes of bowel and mesenteric injury from penetrating trauma 8. Motor vehicle collisions are the most common cause of blunt trauma followed by falls, assaults and sports-related trauma 4,6.

From most to least common sites of bowel injury 1,4,6:

The mechanism of bowel injury include crush/compression type, shearing type (from fixed point of mesentery) and burst type (from increased intra-luminal pressure) and can include 4:

  • perforation
  • mural hematoma or edema
  • active hemorrhage
  • serosal tear
  • degloving (very rare)

Mesenteric injuries can include:

  • definitive signs:
    • visible bowel wall discontinuity 7
    • perforation
      • in blunt trauma, the presence of extra-luminal oral contrast media (if used) or bowel contents; extra-luminal free gas (especially in the absence of pneumothorax/pneumomediastinum) 2
      • in penetrating trauma, extra-luminal free gas is not specific to bowel perforation; extra-luminal contrast media/bowel contents leak and a wound track extending to bowel is considered the most sensitive; wall thickening/mesenteric contusion is less sensitive 2
  • suggestive signs 7
    • mural hematoma: discontinuity in the bowel wall with mural thickening (>3-4 mm); may be complete (i.e. perforated) or incomplete 2,4
    • moderate/large volume of free fluid without solid organ injury 2-3
    • intermesenteric fluid forming triangles
    • abnormal bowel wall enhancement: decreased due to mesenteric vascular interruption and small bowel ischemia, or increased due to vascular permeability secondary to hypoperfusion 7
    • positive seatbelt sign increases the likelihood of traumatic bowel injuries 9
  • definitive signs:
    • active extravasation of contrast media is indicative of active bleeding and a significant mesenteric injury 3
    • intermesenteric free fluid, often forming triangles 7
    • beading and termination of mesenteric vessels 4, 7
    • abrupt termination of the mesenteric vessels 7
    • accumulation ('pooling') of contrast on multiphase imaging
  • suggestive signs 7
    • mesenteric infilatration: haziness and fat stranding
    • mesenteric hematoma
    • bowel wall thickening

Even with increasing non-operative management of traumatic abdominal organs (e.g. liver or spleen laceration), traumatic bowel and mesenteric injuries such as perforation or active mesenteric bleeding still require operative management 3.

  • shock bowel: diffuse bowel wall thickening (from edema) that is hyperenhancing

Article information

rID: 26357
Synonyms or Alternate Spellings:
  • Mesenteric injury
  • Traumatic bowel injury
  • Traumatic mesentery injury
  • Mesentery injury
  • Bowel and mesentery trauma

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Cases and figures

  • Figure 1: colon stab wound (gross pathology)
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  • Figure 2: DJ flexure perforation
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  • Figure 3: jejunal perforation
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  • Case 1: small bowel
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  • Case 2: mesenteric hematoma
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  • Case 3: D-J flexure traumatic perforation
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  • Case 4: jejunal tear
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  • Case 5: colonic injury and mesenteric hematoma
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  • Case 6: evisceration post penetrating injury
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  • Case 7
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  • Case 8: small bowel injury
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  • Case 9
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  • Case 10
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  • Case 11: colonic injury from stabbing
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  • Case 13: from a handlebar injury
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  • Case 12: transverse colon rupture
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  • Case 13: small bowel contusion
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  • Case 14: duodenal and colon injuries
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  • Case 15: skydiving injury
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