Acute traumatic mesenteric bleed

Case contributed by Ian Bickle
Diagnosis certain


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

Patient Data

Age: 50 years
Gender: Male

Moderate volume hemoperitoneum 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 hemoperitoneum.

Annotated image

A trace of contrast extravasation is evident on the portal venous 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 gastrointestinal tract with a relative mobile mesentery (i.e. mesocolon) with rich vasculature contained within. With a deceleration 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 the A&E identified free fluid in the upper abdomen. This was confirmed to be hemoperitoneum 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 hemorrhage.

In this case, surgical exploration confirmed the radiological observation of acute hemorrhage from the distal branches of the inferior mesenteric artery in the sigmoid mesocolon.

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