Isolated middle colic artery injury after blunt abdominal trauma
A 34-year old male patient, victim of motorcycle accident at about 56 miles/hour, was brought into emergency care with a cervical collar. He was hemodynamically stable, with no respiratory or neurological impairment, complaining of diffuse moderate intensity abdominal pain during the physical examination. During secondary evaluation, abrasions were identified on the abdominal wall in the right flank area.
Due to high energy trauma, he underwent a whole body computed tomography (CT) that showed an hematoma in the mesenteric fat planes of the abdomen, and also filling defects in branches of the middle colic artery ( ). The presumptive preoperative diagnosis was vascular mesenteric lesion due to straining. The patient was stabilized, and initially conservative treatment was chosen. During the serial physical examination, persistence of abdominal pain was noted, with no signs of peritonitis. A new CT was performed 20 hours after the first, which revealed dilation and parietal thickening of the right colon, associated with a minimal pneumoperitoneum ( and ).[…]