Fact-sheet: Mesenteric avulsion


Updated on 03/09/2026 at 10:41 AM

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Definition

Gastrointestinal trauma: 5% of abdominal injuries in blunt trauma.
In blunt trauma, the mechanisms are of two types:

  • direct compression
  • deceleration with shearing forces.

Clinical features

Abdominal pain, hemodynamic decompensation.

Often delayed 6 to 12 hours after the trauma.

Ultrasound

Intra-abdominal effusion.

CT

Signs of mesenteric avulsion:

  • Hematoma within the mesentery adjacent to an injured bowel loop or a vascular injury
  • Contrast material extravasation, specifying the origin of the bleeding (venous or arterial)
  • Arterial rupture, sometimes incomplete, contained by an intact adventitia > pseudoaneurysm (extravasation on the arterial phase without increase on the portal phase)
  • Hemoperitoneum
  • Signs of bowel ischemia: local, secondary to vascular rupture, or diffuse due to low flow and shock state
  • Calculation of the Faget-Millet score (see below)

Search +++ for associated lesions: spinal trauma, organ injury...

MRI

Not performed in the emergency setting

Vascular intervention

Possible for emergency hemostasis but often does not replace surgical exploration, which remains recommended as first-line treatment.

Management

Surgical exploration to be discussed

Classification

Faget-Millet prognostic score: Sum of points assigned to the signs

  • Mild hemoperitoneum: +1 point
  • Abundant hemoperitoneum: +3 points
  • Pneumoperitoneum: +5 points
  • Bowel wall thickening: +2 points
  • Active mesenteric contrast extravasation: +3 points
  • Mesenteric infiltration: +2 points
  • Lack of bowel wall enhancement: +1 point
  • Bowel wall rupture: +5 points
  • Spleen injury: -1 point
  • Abdominal wall injury: +2 points

If > 5, surgery

If clinical or CT doubt: early follow-up with a new CT