title: Blunt abdominal trauma and mesenteric avulsion: a systematic review.
abstract: OBJECTIVE
  The aim of this study is to establish the biomechanics, presentation and diagnosis of mesenteric avulsions following blunt abdominal trauma and reach a consensus on their overall management.
  
  
  METHODS
  A systematic review of literature in MedLine, Embase, Scopus and CINHAL in English language from 1951 to November 2014 was performed. A total of 20 reported cases were identified. Variables including patient's demographics, signs and symptoms, mechanism of injury, investigative modality, management, length of stay, follow-up and outcomes were reviewed and analyzed.
  
  
  RESULTS
  The median age of the cohort was 28.5 years (range 10-58 years), with a male-to-female ratio of 3:1. The commonest mechanism of injury was road traffic accident due to seat belt restraint (n = 12, 60 %). The commonest presentation was diffuse abdominal tenderness (n = 10, 45 %) followed by ecchymosis/bruising (n = 9, 40 %). Computed tomography (CT) remained the investigative modality of choice (n = 9, 45 %). All cases had an emergency exploratory laparotomy (n = 18, 90 %) within the initial 24 h and the median length of stay was 19 days (range 4-90 days). The overall mortality was 15 % (n = 3).
  
  
  CONCLUSIONS
  Mesenteric avulsion is rare and has a complex and vague presentation. Due to its potential mortality and morbidity, emergency physicians should keep a high index of suspicion in individuals with blunt abdominal trauma from any mechanism of injury.
authors.affiliation: Mid Essex Hospital Services NHS Trust, Department of General and Vascular Surgery, Broomfield Hospital, Court Road, Essex, CM1 7ET, UK. alikordzadeh@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Kordzadeh
authors.affiliation: Mid Essex Hospital Services NHS Trust, Department of General and Vascular Surgery, Broomfield Hospital, Court Road, Essex, CM1 7ET, UK.
authors.forename: V
authors.initials: V
authors.lastname: Melchionda
authors.affiliation: Department of Accident and Emergency, Southend University Hospital NHS Foundation Trust, Westcliff-on-sea, Essex, SS0 0RY, UK.
authors.forename: K M
authors.initials: KM
authors.lastname: Rhodes
authors.affiliation: Mid Essex Hospital Services NHS Trust, Department of General and Vascular Surgery, Broomfield Hospital, Court Road, Essex, CM1 7ET, UK.
authors.forename: E O
authors.initials: EO
authors.lastname: Fletcher
authors.affiliation: Mid Essex Hospital Services NHS Trust, Department of General and Vascular Surgery, Broomfield Hospital, Court Road, Essex, CM1 7ET, UK.
authors.forename: Y P
authors.initials: YP
authors.lastname: Panayiotopolous
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D000063:Accidents, Traffic; D001696:Biomechanical Phenomena; D042241:Early Diagnosis; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D008643:Mesentery / Q000000981:diagnostic imaging / Q000293:injuries*; D061330:Multidetector Computed Tomography; D012017:Referral and Consultation; D012622:Seat Belts / Q000009:adverse effects*; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery
keywords: Blunt abdominal Trauma; Mesenteric avulsion; Mesenteric laceration; Mesenteric tear; Seat belt syndrome; Systematic review