Show Summary Details
Page of

Case 166 

Case 166
Chapter:
Case 166
Author(s):

Angela D. Levy

, Koenraad J. Mortele

, and Benjamin M. Yeh

DOI:
10.1093/med/9780199759439.003.0166
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2020. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

Subscriber: null; date: 12 July 2020

History

  • 40-year-old man complains of abdominal pain following a motor vehicle accident.

Case 166

Diagnosis

Case 166 Mesenteric Hematoma

Case 166

Findings

A large heterogeneous mass with central high attenuation involves the transverse mesocolon. Active extravasation of intravenous contrast (arrows) indicates active hemorrhage. The adjacent bowel is normal in appearance.

Differential Diagnosis

  • Mesenteric bleeding: suggested in the setting of blunt abdominal trauma, high attenuation fluid and active extravasation within a mesentery. If the CT scan had been performed with bowel contrast, a bowel perforation would have been a possibility; free air would most likely be present.

Teaching Points

Mesenteric hemorrhage in the setting of blunt trauma is uncommon. When detected, reporting the severity of the hemorrhage and the presence or absence of significant bowel injury (laceration, perforation, or ischemia) is critical to triage patients to surgical intervention or observation. Mesenteric hematomas tend to be focal, well-defined masses that are the result of mesenteric vascular laceration. They may be triangular, round, or oval in shape. Acute hemorrhage is generally high in attenuation (50 to 60 HU) and becomes less attenuating over time. The finding of intravenous contrast extravasation in the region of the hematoma is indicative of active bleeding. Irregularity of the mesenteric vessels, often termed mesenteric beading, and abrupt termination of vessels may also indicate mesenteric vascular injury. In some cases, the hemorrhage in the mesentery is less well defined such that the mesentery appears hazy, infiltrated, or indistinct.

Management

The finding of active hemorrhage within a mesenteric hematoma or associated bowel perforation or ischemia indicates surgery is necessary. Less significant injuries such as an isolated mesenteric hematoma without evidence of active bleeding can be managed conservatively.

Further Readings

1. Dowe M. F., Shanmuganathan K., Mirvis S. E., Steiner R. C. and Cooper C. CT findings of mesenteric injury after blunt trauma: implications for surgical intervention. Am J Roentgenol. 1997; 168: 425–428.Find this resource:

    2. Hanks P. W. and Brody J. M. Blunt injury to mesentery and small bowel: CT evaluation. Radiol Clin North Am. 2003; 41: 1171–1182.Find this resource: