Bucket handle mesenteric tear with seatbelt sign following a motor vehicle accident: a case report

Abstract

Background: Traumatic bucket-handle mesenteric injury is exceptionally rare, as only 20 cases were reported during the past 63 years. It is a life-threatening injury that is difficult and challenging to detect during bedside physical examination and requires typical diagnostic tests such as CT scan. It occurs when the mesentery avulses off, a bowel loop becomes devascularized and can likewise become ischemic and perforated if left untreated. Most commonly it is caused by motor vehicle crush. Case Presentation: A 23-year-old male was brought to the emergency department as a case of motor vehicle accident with frontal impact. The patient was the driver and wearing the seat belt. Abdominal examination revealed a seat belt sign, generalized tenderness and rigidity, and absence of bowel sound by auscultation. However, patient lacked any related external wounds or injuries. Despite being clinically and vitally stable with no indications requiring the presence of the trauma surgeon, the emergency physician activated the trauma team code based on their clinical judgment. Eventually the patient was taken to operation room for laparotomy as the patient was having acute abdomen, and Bucket-Handle mesenteric tear was identified even though abdomen CT didn't show specific findings. Conclusion: The study concluded that delaying in the diagnosis of traumatic bucket-handle mesenteric injuries and definitive surgical interventions could lead to adverse outcomes and death.