www.ijcasereportsandimages.com Missed mesenteric injury in blunt abdominal trauma: A potentially lethal error Victor Kong, John Burce, George Oosthuizen, Grant Laing, Damian Clarke ABSTRACT Introduction: Mesenteric injury following blunt abdominal trauma is uncommon. Delay in diagnosis is unfortunately common due to its subtle clinical presentation and is associated with significant morbidity and mortality. Case Report: We present a case of a 35-year-old male who was discharged home with a missed mesenteric injury. The initial computed tomography scan of the abdomen and pelvis was normal. He re-presented acutely with small bowel infarction. Conclusion: Although computed tomography is the current gold standard of investigation, a very small proportion of injuries that require surgical intervention will invariably be missed. This case highlights several pitfalls in evaluation of these patients. Clinicians must always be vigilant of such injury despite normal radiological studies. A sufficient period of observation post injury should be considered in circumstances where the possibility of mesenteric injury is increased. Such circumstances include lack of seat belt usage, high-speed impact and deceleration injury. Keywords: Mesentery, Trauma, Missed injuries, Blunt ********* Kong V, Burce J, Oosthuizen G, Laing G, Clarke D. Missed mesenteric injury in blunt abdominal trauma: A potentially lethal error. International Journal of Case Reports and Images 2013;4(7):376–379. ********* doi:10.5348/ijcri-2013-07-335-9 INTRODUCTION Mesenteric injury following blunt abdominal trauma is uncommon and the diagnosis is particularly difficult as clinical presentation is often subtle [1, 2]. Although computed tomography (CT) scan of the abdomen is the method of choice for the evaluation of these patients, in a very small proportion of cases, the diagnosis can invariably be missed and could potentially lead to disastrous outcome [3]. We present a case of massive mesenteric disruption complicated by small bowel infarction in a 35-year-old male who had subtle clinical signs and normal CT scan of the abdomen on initial evaluation. CASE REPORT A 35-year-old male was presented to our trauma unit following a motor vehicle accident. He was the driver (unrestrained) of a mini-vehicle traveling at high speed, when it collided with a power post. The vehicle