Bucket handle mesenteric injury
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Bucket handle mesenteric injuries are avulsions of the mesentery off a bowel segment (the handle) due to shearing forces in blunt trauma to the bowel and mesentery. Laceration of the mesenteric vessels results in intestinal ischemia.
The most common mechanism of injury involves a seatbelt-restrained driver or passenger in a motor vehicle crash 1,2. Other mechanisms include bicycle handlebar injury, fall from a height, or assault 1,2. The injury is commonly missed at the time of trauma and patients present one to several days later due to the development of bowel ischemia and necrosis.
Bucket handle injuries are considered the highest grade of blunt mesenteric injury due to devascularization, as compared to lacerations or hematomas without devascularization 1,3.
Common sites of injury include the proximal jejunum (near the ligament of Treitz) and the distal ileum (near the ileocecal valve) due to points of fixation between a mobile peritoneal bowel segment and the retroperitoneum 1.
Bucket handle injuries are frequently difficult to detect on initial trauma CT. Signs that suggest a surgically significant mesenteric and bowel injury in general include active bleeding (contrast extravasation) from a mesenteric vessel, abnormal decreased contrast enhancement of bowel wall, and interloop fluid 1,3.
The presence of a traumatic abdominal wall hernia, especially lumbar hernia, should raise the suspicion of an associated surgically significant mesenteric injury 1. Around one-fifth of patients with mesenteric avulsion injuries have a lumbar hernia 1,3.
Treatment and prognosis
- 1. Extein JE, Allen BC, Shapiro ML, Jaffe TA. CT Findings of Traumatic Bucket-Handle Mesenteric Injuries. (2017) AJR. American journal of roentgenology. 209 (6): W360-W364. doi:10.2214/AJR.17.17927 - Pubmed
- 2. Nosanov LB, Barthel ER, Pierce JR. Sigmoid perforation and bucket-handle tear of the mesocolon after bicycle handlebar injury: a case report and review of the literature. (2011) Journal of pediatric surgery. 46 (12): e33-5. doi:10.1016/j.jpedsurg.2011.09.045 - Pubmed
- 3. Tilden W, Griffiths M, Cross S. Vascular bowel and mesenteric injury in blunt abdominal trauma: a single centre experience. (2020) Clinical radiology. doi:10.1016/j.crad.2020.09.022 - Pubmed
- 4. Alabousi M, Mellnick VM, Kashef Al-Ghetaa R, Patlas MN. Imaging of blunt bowel and mesenteric injuries: Current status. (2020) European journal of radiology. 125: 108894. doi:10.1016/j.ejrad.2020.108894 - Pubmed