Bucket Handle Injury in Blunt Abdominal Trauma.

CASE PRESENTATION: A 52-year-old man involved in a high-speed car crash presented with hypotension, abdominal and back pain, and seatbelt bruising. Imaging revealed a mesenteric bucket-handle injury with active bleeding. He received resuscitation and was taken emergently to the operating room for a sigmoid colectomy with primary anastomosis.

DISCUSSION: In patients with blunt abdominal trauma, 1-6% are diagnosed with mesenteric or hollow visceral injuries; the bucket handle injury is a subtype of these injuries. These injuries often present subtly and may be missed on initial evaluation, particularly when the extended focused assessment with sonography for trauma is negative. Unexplained hemodynamic instability should prompt further investigation, as delayed diagnosis can lead to bowel ischemia or infarction. Early recognition and surgical intervention are critical to reducing morbidity and mortality in these patients.