Mesenteric injury from blunt abdominal trauma.

Mesenteric injury from blunt abdominal trauma is rare and can be difficult to diagnose. Twenty-seven cases were admitted over the past 5 years to our Level I trauma center. These cases have been retrospectively reviewed to better define the experience of patients with blunt mesenteric injury for the physician faced with making this diagnosis. It was found that the diagnosis of mesenteric injuries tends to be delayed in a certain subset of patients. Patients with a devascularizing, isolated injury or patients who are evaluated by abdominal CT scan (as opposed to DPL) tended to be more likely to experience a diagnostic delay. It was also found that motor vehicle accidents are the most common, though not the only, mechanism of injury and that the mesentery of the small bowel is injured approximately five times more frequently than the colonic mesenteries. These factors, however, did not result in earlier diagnostic decision making. To decrease the likelihood of a missed diagnosis, physicians should entertain the possibility of mesenteric injury in all patients presenting with blunt abdominal trauma, even if few clinical findings are initially present and/or an abdominal CT scan demonstrates no definitive intraabdominal injury.