Perforation of the Meckel’s Diverticulum Following Blunt Trauma to the Abdomen

Abstract

Bhattarai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Meckel’s Diverticulum Injuries after Blunt Trauma

“…Pressure rupture occurs when the lumen of the intestine is closed and compression increases the internal pressure, causing a weak spot to rupture. In contrast, crushing occurs when a direct blow crushes a segment of the intestine against a relatively immobile and rigid structure, such as a vertebra [ 32 ]. The mechanism of MD injury after blunt trauma associated with strong abdominal compression is confirmed in the analyzed material.…”

“…The mechanism of MD injury after blunt trauma associated with strong abdominal compression is confirmed in the analyzed material. In four cases, the person hit the bicycle handlebar [ 14 , 19 , 30 , 32 ]. Two people in cars were held by seat belts [ 10 , 15 ].…”

“…Another indicated mechanism leading to the perforation of MD in blunt trauma is the action of shearing forces during deceleration [ 10 , 15 , 32 ]. Referring to damage to the small intestine after blunt trauma, it has been proposed that such shearing forces are generated by sudden deceleration or acceleration, e.g., in a fall from a height or in a traffic accident; in such cases, a sudden stop causes the intestine to move forward, while the constant (fixed) points such as the duodenojejunal flexure and ileocaecal junction take the force and are torn away [ 32 ]. In contrast, Almatrfi et al report that rupture of the MD after blunt abdominal trauma is rare because it is not attached to the ligaments or mesentery, and acceleration or deceleration injury is not expected in such cases [ 30 ].…”

“…Several possible mechanisms may contribute to post-traumatic damage to Meckel's diverticulum (MD), particularly its perforation. Some authors propose that post-traumatic perforation of MD may be caused by increased pressure [9,10,15,29,30,32], the transfer of a sudden increase in intra-abdominal pressure to the intestinal lumen [30], or intra-abdominal pressure [29]; however, one study fails to specify the nature of the pressure increase [9]. In our opinion, MD rupture may be caused by increased intra-abdominal pressure alone, without any accompanying increase in pressure in the intestinal lumen.…”

“…In turn, post-traumatic perforation of MD appears to result from the diverticulum being crushed between the anterior abdominal wall and the vertebrae [24]. Bhattarai et al propose that pressure rupture occurs when the intestinal loop is trapped by the closure of its lumen; the resulting compression increases the internal pressure, causing the intestinal wall to rupture at the weakened site [32]. The authors also mention pressure rupture and crushing as possible mechanisms of small intestine perforation in blunt trauma.…”