Bucket handle mesenteric injury

Last revised by Rohit Sharma on 2 Jan 2023

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.

Surgery is required to remove the devitalized bowel segment. Progression of untreated bowel ischemia leads to bowel necrosis, perforation, pneumoperitoneum, peritonitis, and sepsis 1.

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Cases and figures

  • Case 1: mesenteric traumatic lacerations
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  • Case 2: mesenteric avulsion
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