The
mesentery
A wound of the mesentery can follow a severe
abdominal contusion and is a cause of haemoperitoneum.
Seat-belt
syndrome
If a car accident occurs when a seat belt is
worn, sudden deacceleration can result in a torn mesentery. This possibility
should be borne in mind particularly as multiple injuries may distract attention
from this injury. If there is any bruising of the abdominal wall, or even marks
of clothing impressed into the skin, laparotomy may be indicated.
Diagnostic
peritoneal lavage
Diagnostic peritoneal lavage may be helpful in
this situation (Chapter 4). Under local anaesthetic a subumbilical incision is
made down to the peritoneum in a similar way to that used for ‘open’
laparoscopy (see above). A purse-string suture is placed in the peritoneum which
is then incised. Free fluid, e.g. blood or intestinal contents, may be found,
but if not a peritoneal dialysis catheter is inserted and the purse-string suture tied. A litre of normal saline is run
into the peritoneum and then drained off by placing the bag and tubing below
the patient’s abdomen. The presence of blood (>100 000 red blood cells/mm3),
bile or intestinal contents is an indication for laparotomy. In about 60 per
cent of cases, the mesenteric laceration is associated with a rupture of the
intestine. If the tear is a large one and especially if it is transverse (Fig.
56.14a),
the
blood supply to the neighbouring intestine is cut off and a limited resection of
gut is imperative. Small wounds and wounds in the long axis (Fig.
56.14b) should
be sutured. If extensive damage to the mesenteric arcade of vessels is
associated with damage to contiguous intestine, exteriorisation of the damaged
segment is preferable to excision and suture.
Torsion
of the mesentery
See volvulus neonatorum, and volvulus of the
small intestine, Chapter 58.
Embolism
and thrombosis of mesenteric vessels
See Chapters 57 and 58.