PDF(Pubmed)
Abstract：
Bucket-handle mesenteric tears remain a diagnostic challenge for clinicians. We aim to review the literature, including a single-surgeon series, to better understand their presentation and management. Three electronic databases (Ovid Medline, Embase, and PubMed) were searched for original research articles, describing relevant cases, from database inception to October 2021 using the following Medical Subject Heading (MeSH) terms: mesenteric avulsion, mesenteric tear, and blunt abdominal trauma. A retrospective review of cases managed under a single surgeon at our unit was also performed. Data extracted included demographics, mechanism of injury, presenting features, diagnostic imaging, surgical management, and patient outcome. In total, 19 studies were identified, including 22 patients (median age 34.5 years). The most common cause of injury was seat-belted road traffic accidents (77.3%), and patients commonly presented with abdominal pain (72.7%), tenderness (50%), positive seat-belt sign (54.5%), and haemodynamic compromise (45.5%). Computerised tomography scanning was the main imaging modality (68%), and the most common findings reported were abdominal free fluid (36.4%) and abdominal wall hernia (27.3%). The majority of patients were operated on within 24 hours of injury (68%), had a median length of stay of 14.5 days, and experienced an uncomplicated recovery (68%). There was no association between the development of complications and delayed surgical intervention >24 hours (p = 0.145). Our institution\'s experience was similar, with 50% of patients undergoing surgical intervention within 24 hours. The median age was 32.5 years (50% female), and the median length of stay was 11 days. A high index of suspicion, serial monitoring, including blood tests, and imaging, with a low threshold for early repeat imaging, can provide a useful guide for identifying patients with bucket-handle tears.
摘要：
桶柄肠系膜撕裂仍然是临床医生的诊断挑战。我们的目标是回顾文献，包括一个单外科医生系列，更好地理解他们的表现和管理。三个电子数据库(OvidMedline，Embase,和PubMed)搜索原始研究文章，描述相关案例，从数据库开始到2021年10月，使用以下医学主题标题(MeSH)术语：肠系膜撕脱，肠系膜撕裂,腹部钝性外伤.还对我们单位由一名外科医生管理的病例进行了回顾性审查。提取的数据包括人口统计，损伤机制,呈现特征，诊断成像,手术管理,和患者的结果。总的来说,确定了19项研究，包括22名患者（中位年龄34.5岁）。最常见的伤害原因是座椅安全带道路交通事故(77.3%),患者常出现腹痛（72.7%），压痛（50%），积极的安全带标志（54.5%），和血液动力学损害（45.5%）。计算机断层扫描是主要的成像方式（68％），最常见的发现是腹腔游离液(36.4%)和腹壁疝(27.3%)。大多数患者在受伤后24小时内进行了手术（68％），平均住院时间为14.5天,并经历了简单的恢复（68％）。并发症的发生与手术治疗延迟>24小时之间没有关联（p=0.145）。我们机构的经验是相似的，50%的患者在24小时内接受手术干预。中位年龄为32.5岁（50%为女性），中位住院时间为11天。高度怀疑，串行监控,包括验血,和成像，早期重复成像的阈值较低，可以为识别桶柄眼泪患者提供有用的指导。
