Mesenteric injury (case studies)

We can now reinforce the concepts of CT evaluation for bowel injury lesson by reviewing a series of real CT cases. We explore different injuries that can occur in the mesentery and find out how the bowel responds to blood loss and shock.

Case 1: Crush injury

A 40 year old male is transferred to emergency by ambulance after being pinned against a wall by a bobcat. He is complaining An abdominal CT scan is performed.

Abdominal CT imaging

There is stranding and dense fluid in the mesentery (called mesenteric haematoma, which surrounds the duodenum and pancreas). On the coronal image, you can see a second haematoma in the lower abdominal ileocolic mesentery.

Abdominal CT Trauma mesenteric vessel crush injury
Stranding and dense fluid indicates haematoma


This patient was taken for exploratory surgery and was found to have duodenal and mesenteric haematomas, but no bowel tear, perforation, or ischemia.

Case 2: High velocity crash

Our next patient was in a high velocity crash and was ejected from the vehicle.

In this case, there is a large transverse mesocolon haematoma with active bleeding. Active bleeding can be diagnosed by looking for streaks of bright, contrast-mixed blood that follow an irregular path and spread out over time.

Abdominal CT Trauma mesenteric vessel MVA injury
Axial view


This patient was also taken to surgery to control the bleeding.

Case 3: Shock bowel

What causes a diffusely thickened and enhanced bowel but no specific bowel injury? I’m talking about shock bowel which occurs during hypotensive shock due to blood loss and hypoperfusion of the bowel. Shock bowel is part of something called the CT hypoperfusion complex, which refers to the abdominal imaging features commonly seen in profound hypotension.

Shock bowel is identified as a pattern of abnormal enhancement of the organs and bowel on CT imaging. The characteristic appearance includes increased organ enhancement and bowel wall thickening.

In these images, you can see the duodenal and jejunal mucosa is quite thickened and bright with the darker folds representing submucosal oedema.

Abdominal CT Trauma mesenteric vessel shock bowel

Other typical findings include flattening of the inferior vena cava which supports the diagnosis of hypovolaemia.

Abdominal CT Trauma mesenteric vessel flat vena cava
Flattening of the inferior vena cava


Even the most subtle signs of potential bowel injury should be communicated early so the surgical team can consider exploration or close follow up with serial examinations.

This is an edited excerpt from the Medmastery course Abdomen CT: Trauma by Michael P. Hartung, MD. Acknowledgement and attribution to Medmastery for providing course transcripts


Radiology Library: Abdominal Trauma. Solid organ injury

Abdominal CT interpretation

Assistant Professor of Abdominal Imaging and Intervention at the University of Wisconsin Madison School of Medicine and Public Health. Interests include resident and medical student education, incorporating the latest technology for teaching radiology. I am also active as a volunteer teleradiologist for hospitals in Peru and Kenya. | Medmastery | Radiopaedia | Website | Twitter | LinkedIn | Scopus 

Dr Adam Brown LITFL Author

MBChB (hons), BMedSci - University of Edinburgh. Living the good life in emergency medicine down under. Interested in medical imaging and physiology. Love hiking, cycling and the great outdoors.

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