Subtle mesenteric avulsion in a traumatic abdominal wall hernia: A case report.
BACKGROUND
Traumatic abdominal wall hernias (TAWHs) are uncommon and to date less than 50 cases have been reported in the literature. Furthermore mesenteric avulsion is a rare complication of TAWHs and occurs in less than 5% of all cases.


METHODS
A 47-year-old lady presented to the emergency department after a road traffic accident. In spite of seat belt use and airbag deployment, the patient presented with a visible left paramedian abdominal mass, which was tender and irreducible on examination. Subsequent computed tomography (CT) of the abdomen confirmed herniation of the small bowel with no free air or fluid in an otherwise stable patient. Intra-operative findings confirmed mesenteric avulsion and bowel necrosis.


CONCLUSIONS
The role of emergency or elective repair of TAWHs remains unclear. As 58% of blunt mesenteric and bowel injuries due to avulsion are missed on initial work-up, it is advisable for clinicians to balance the risk of unnecessary and non-therapeutic emergency laparotomy with the morbidity and mortality associated with delay in diagnosis.


CONCLUSIONS
Mesenteric avulsion in TAWH is rare and difficult to diagnose and a high index of suspicion is warranted despite normal findings on initial assessments.
Mid Essex NHS Trust, Department of General & Vascular Surgery, Broomfield Hospital, Essex CM1 7ET, UK.
Ali
A
Kordzadeh
Arjun
A
Devanesan
Tim
T
Parkinson
Kiran
K
Rahim
Yiannis
Y
Panayiotopoulos