Teaching image withheldThe image will be revealed when it becomes clinically available in the case.
OPERATIVE image acquired after emergency laparotomy: an open abdominal field with a clinician-confirmed traumatic bucket-handle small-bowel/mesenteric injury. The supplied photograph should be interpreted only after the operative pathway has been established. • TEACHING IMAGE
Seatbelt Sign to Operative Discovery: Traumatic Bucket-Handle Bowel Injury
SCENARIO
An adult restrained driver is brought after a high-speed motor-vehicle collision. There is a prominent lower abdominal seatbelt sign and abdominal tenderness. Initial airway and breathing assessments are adequate. Circulation is supported with blood products and limited crystalloid; the patient remains responsive for immediate trauma assessment but develops worsening abdominal pain and borderline perfusion. FAST demonstrates free intraperitoneal fluid. Because the patient has evolving perfusion concern and a positive FAST, the trauma team proceeds to emergency exploratory laparotomy rather than delaying for CT. The supplied operative photograph is obtained after the abdomen is opened.