A Case of Traumatic Mesenteric Injury Following High-Energy Trauma in a Patient Who Walked into Our Hospital for Consultation

Abstract

A 39-year-old man whose abdomen had become trapped under the weight of two iron plates 4 hours previously walked into our hospital for consultation with the chief complaint of abdominal pain. We judged the patient as a case of high-energy trauma and immediately applied Japan Advanced Trauma Evaluation and Care (JATEC) procedures. During the primary survey, we recognized abnormalities in circulation, and focused sonographic assessment for trauma revealed an intra-abdominal fluid collection. He was diagnosed as being in hemorrhagic shock due to intra-abdominal bleeding and initiated on fluid resuscitation. After his circulatory condition stabilized, the secondary survey confirmed the initial diagnosis of isolated mesenteric injury. He was transferred to the high care unit where he underwent non-operative management, including blood transfusion. Four hours later, he developed circulatory failure, and emergency surgery was performed under the diagnosis of a transient responder. Laparotomy revealed mesenteric defects with blood oozing at two separate locations in the small intestine. No gastrointestinal perforations or other intra-abdominal organ injuries were observed. Therefore, we performed small bowel resection to remove the mesenteric defects, followed by end-to-end anastomosis. The postoperative course was uneventful, and the patient was discharged from our hospital on foot in an ambulatory state on the 10th postoperative day.