Acute traumatic mesenteric bleed

Case contributed by Dr Ian Bickle

Presentation

Passenger wearing seatbelt in a car hit from side in an RTA. Lower abdominal pain.

Patient Data

Age: 49
Gender: Male
Modality: CT

Moderate volume haemoperitoneum in the upper abdomen and pelvis surrounding the sigmoid colon.

Small laceration of spleen.

Active accumulation of contrast in the sigmoid mesocolon, which increases on delayed images, associated with the pelvic haemoperitoneum.

Modality: Annotated image

A trace of contrast extravasation is evident on the PV phase in the left side of the pelvis ( red arrow ).

On the delayed phase the volume of contrast pooling at this site has significantly increased ( blue arrows )

Case Discussion

Seat belt injuries are classified as blunt trauma. A number of injuries are more likely in the context of blunt trauma, one of which is a mesenteric tear.

The sigmoid colon is one part of the gastro-intestinal tract with a relative mobile mesentery with significantly vasculature contained within. With a de-acceleration injury it is vulnerable to tearing.

Given the force of impact other injuries, such as solid organ lacerations, are often associated.

A prior FAST scan by a clinician in A&E identified free fluid in the upper abdomen. This was confirmed to be haemoperitoneum on CT.

Active bleeding may be evident on CT in the form of contrast extravasation or if multiphase imaging is acquired, the associated pooling of contrast at the site of haemorrhage.

Surgical exploration in this case confirmed the radiological observation of acute haemorrhage from the distal branchs of the inferior mesenteric artery in the sigmoid mesocolon.

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Case Information

rID: 37561
Case created: 13th Jun 2015
Last edited: 7th Sep 2015
Inclusion in quiz mode: Included

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