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.