Bucket-handle mesenteric injuries in blunt abdominal trauma: Diagnostic challenges and surgical imperatives

Bucket-handle mesenteric injuries represent a severe and frequently under-recognized subset of blunt abdominal trauma.These injuries result from shearing forces during rapid deceleration, leading to avulsion of the mesentery from the bowel wall and consequent disruption of vascular supply.Though uncommon, they carry a high risk of morbidity because early clinical signs may be minimal, allowing devascularized bowel to progress silently toward necrosis and perforation.Here we present a case of a 23-year-old male who sustained a road traffic injury.He presented after 3 hours of injury.On presentation, he had tachycardia (Pulse 121/min) and blood pressure 90/60.He was given 1 Liter of bolus Ringer's lactate; however, he did not respond to the fluid challenge.A bedside FAST examination was done, which showed positive findings in hepatorenal (HR), left upper quadrant (LUQ), and pelvis.He was immediately shifted to the operative room (OR), where 1 liter of blood was evacuated.On examination, he had a bucket handle tear in the mesentery, which was resected, and a primary anastomosis was done [Figure 1].He made an uneventful recovery.