Traumatic mesenteric bleeding: early diagnosis and interventional management

Excerpt

A 27-year-old man was admitted to the emergency department after a motorcycle accident. He had an occipital head contusion (Glasgow coma scale 15), bruises on the right thigh and right anterior chest wall. Whole-body computed tomography (CT) was performed because of a highspeed motor vehicle collision although vital parameters were not compromised and there was no abdominal pain. Non-enhanced and contrast-enhanced CT in arterial and venous phase demonstrated mesenteric hematoma and extravasation of contrast material adjacent to ileal branches of the superior mesenteric artery (Fig. 1). Since no major injuries of parenchymal organs, pneumoperitoneum or bowel wall thickening were detected, transcatheter arterial embolization (TAE) was chosen as a firstline treatment to control bleeding. A selective superior mesenteric angiogram performed via the right femoral approach revealed that the ileal branch of the superior mesenteric artery was disrupted distal to a pseudoaneurysm (Fig. 2b). Control angiography showed disappearance of the pseudoaneurysm and cessation of contrast material extravasation (Fig. 2c). The patient remained hemodynamically stable with no complications during the 5 months following TAE.

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