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Intracorporeal laparoscopic management of mesenteric avulsion in a blunt trauma patient.

The role of laparoscopy in trauma was first described in 1920 for its ability to identify hemoperitoneum.1,2 Since then, laparoscopy has gained favor in many trauma centers in the evaluation of trauma patients because of a decrease in morbidity, pain, and complications associated with standard laparotomy and thoracotomy. Laparoscopy also provides the potential ability to identify injuries missed with other diagnostic methods. Negative laparotomy rates ranging between 12% and 40%, as well as longer length of stay after a laparotomy, make laparoscopy an appealing alternative in the management of trauma patients. Initially, laparoscopy was advocated mainly for diagnostic purposes in the setting of trauma.3–6 More recently, as skills have improved, laparoscopy has become increasingly used as a therapeutic modality. The majority of therapeutic interventions described have involved control of bleeding from liver or spleen lacerations, repair of diaphragmatic injuries, and stapling of gastrotomies.7–9 However, there have been no reports of the use of laparoscopy for intracorporeal small bowel resection in the setting of blunt trauma. We describe a case of extensive mesenteric avulsion with hemoperitoneum and ischemic bowel, treated successfully with laparoscopy alone.