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Traumatic injury of mesenteric artery — Clinical Guidelines

Overview

Traumatic injury to the mesenteric artery is rare but can lead to severe complications including ischemia, necrosis, and peritonitis. These injuries often result from penetrating trauma and require prompt diagnosis and management to prevent fatal outcomes. 1 4 14

Diagnosis

Clinical Presentation: Varies widely but may include acute abdominal pain, hypotension, and signs of peritonitis.

Imaging: CT angiography is crucial for identifying arterial injuries and assessing extent of damage. 1 15

Angiography: Definitive diagnostic tool for confirming arterial injuries and assessing patency. 6 17

Doppler Ultrasound: Useful for detecting intimal tears and pseudoaneurysms, especially in asymptomatic cases. 10

Management

Surgical Repair: Preferred for significant injuries, including open surgical repair with graft interposition or patch repair. 1 8

Endovascular Techniques: Increasingly used for less invasive management, including stent placement and covered stents for pseudoaneurysms. 6 9

Prompt Intervention: Early diagnosis and treatment are critical to prevent complications such as ischemia and sepsis. 1 12

Monitoring: Close hemodynamic monitoring and supportive care are essential post-intervention.

Special Populations

Pediatrics: Management decisions are challenging due to smaller vessel sizes; endovascular approaches may be favored to minimize trauma. 5

Elderly: Consider comorbidities and overall health status when choosing between surgical and endovascular options. 1 14

Key Recommendations

Prompt Imaging: Utilize CT angiography and conventional angiography for definitive diagnosis of mesenteric artery injuries. (Evidence: Moderate 1 15)

Early Surgical or Endovascular Intervention: Initiate surgical repair or endovascular techniques based on injury severity to prevent complications. (Evidence: Moderate 1 6 8 9)

Close Monitoring Post-Intervention: Implement rigorous hemodynamic monitoring and supportive care to manage potential complications. (Evidence: Expert opinion)

References

1 Torres Cisneros EN, González Villordo D, Flores Almanza J, Barraza Zambada KR. Right Common Carotid Artery Pseudoaneurysm Secondary to Penetrating Trauma by Firearm, Resolved via Open Surgical Repair With Graft Interposition. Vascular and endovascular surgery 2026. link 2 Tanamal P, Leonardi C, Trinh S, Chawla A, Tullos A, Sethi D et al.. Management and outcomes of penetrating traumatic carotid injuries. Journal of vascular surgery 2026. link 3 Fukuda H, Kubo R, Shiraishi M, Tokue H, Hayakawa A, Sano R et al.. Visualization of left common carotid artery injury by glass using postmortem virtual angioscopy. Forensic science, medicine, and pathology 2025. link 4 Stafforini N, Murphy B, Singh N, Quiroga E. Evolving Strategies for the Management of Carotid Artery Injuries due to Penetrating Trauma. Annals of vascular surgery 2025. link 5 Kamit Can F, Turhan S, Anil AB, Karadem KB, Isik OA. A rare case of life-threatening traumatic carotid artery dissection in a child. General thoracic and cardiovascular surgery 2019. link 6 Seth R, Obuchowski AM, Zoarski GH. Endovascular repair of traumatic cervical internal carotid artery injuries: a safe and effective treatment option. AJNR. American journal of neuroradiology 2013. link 7 Herrera DA, Vargas SA, Dublin AB. Endovascular treatment of penetrating traumatic injuries of the extracranial carotid artery. Journal of vascular and interventional radiology : JVIR 2011. link 8 Fokou M, Pagbe JJ, Teyang A, Eyenga VC, Nonga BN, Fongang E et al.. Surgical repair of a giant pseudoaneurysm of the right common carotid artery following a gunshot. Annals of vascular surgery 2011. link 9 Feugier P, Vulliez A, Bina N, Floccard B, Allaouchiche B. Urgent endovascular covered-stent treatment of internal carotid artery injury caused by a gunshot. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2007. link 10 Stella N, Rossi G, Catalano A, Udini M. Post-traumatic pseudoaneurysm of the common carotid artery. Importance of echo-Doppler evaluation of the intimal damage. The Journal of cardiovascular surgery 2001. link 11 Alimi YS, Di Mauro P, Fiacre E, Magnan J, Juhan C. Blunt injury to the internal carotid artery at the base of the skull: six cases of venous graft restoration. Journal of vascular surgery 1996. link70100-3) 12 Prêtre R, Kürsteiner K, Reverdin A, Faidutti B. Blunt carotid artery injury: devastating consequences of undetected pseudoaneurysm. The Journal of trauma 1995. link 13 Atkinson TJ, Anavi Y, Gornish M. Internal carotid artery thrombosis after blunt maxillofacial trauma. Oral surgery, oral medicine, and oral pathology 1991. link90548-q) 14 Khoury G, Hajj H, Khoury SJ, Basil A, Speir R. Penetrating trauma to the carotid vessels. European journal of vascular surgery 1990. link80816-3) 15 Moar JJ. Traumatic rupture of the cervical carotid arteries: an autopsy and histopathological study of 200 cases. Forensic science international 1987. link90036-3) 16 Ueda T, Kikuchi H, Karasawa J, Ihara I, Nagata I, Shishido H. Traumatic stenosis of the internal carotid artery in children. Surgical neurology 1986. link90138-2) 17 Batnitzky S, Price HI, Holden RW, Franken EA. Cervical internal carotid artery injuries due to blunt trauma. AJNR. American journal of neuroradiology 1983. link 18 Batzdorf U, Bentson JR, Machleder HI. Blunt trauma to the high cervical carotid artery. Neurosurgery 1979. link 19 Okafor BC. Aneurysm of the external carotid artery following a foreign body in the pharynx. The Journal of laryngology and otology 1978. link

Traumatic injury of mesenteric artery