Mesenteric avulsion

Case contributed by Liz Silverstone


140kph car crash.

Patient Data

Age: 20 years
Gender: Male

Transverse band of sub-cutaneous fat stranding across the lower anterior abdomen.

Small volume hemoperitoneum.

Mesenteric thickening, stranding, and fluid across the lower abdomen.

Fractured anterosuperior corner of L3.

Case Discussion


  • mesenteric tears and vascular injuries

  • infarcted terminal ileum necessitating partial ileocolectomy

  • muscle tear of the rectum treated by high anterior resection

PR bleeding continued for 4 days and then settled.

Vascular, bowel and mesenteric injuries are often missed or under-diagnosed. Intermittent hemorrhage from vascular injuries is common. The terminal ileum is one of the relatively fixed areas of the bowel which are prone to injury.

Transverse subcutaneous fat-stranding is the radiological corollary of the seatbelt sign. The small L3 fracture is an indicator of the force of the trauma.

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