Due to the CT findings suspicious for mesenteric injury and the moderate amount of hemoperitoneum, along with the decreased hemoglobin (Hb of 7 g/dL), it was decided to bring the patient to the operating room. Exploratory laparotomy was performed, which revealed two mesenteric lacerations affecting 10-15 cm of jejunal loops with approximately 600 cc of hemoperitoneum. An additional laceration was found at the sigmoid mesocolon, with no clear correlated findings at the CT study. The surgery team resected the affected intestinal segments and the patient recovered satisfactorily from the postoperative period.

This case illustrates how the presence of hemoperitoneum with no associated solid organ injury, in the context of abdominal trauma, should raise the concern of bowel and/or mesenteric injury. Mesenteric lacerations are rare injuries that can only be diagnosed intraoperatively, but they can be suspected when encountering mesenteric areas of increased attenuation, fat stranding and bowel abnormalities. When only indirect findings of mesenteric/bowel injury are present, as was in this patient, the need for surgical intervention relies more on clinical judgment.