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From question on page 163
All layers of the bowel wall, especially the submucosa, are expanded by extravasated erythrocytes (fig 1A
) with venous engorgement and leakage through vein walls (fig 1B). These findings are typical of mesenteric venous obstruction, as commonly seen in mesenteric venous thrombosis, and distinct from jejunal haematomas associated with anticoagulation. No venous thrombi were present and arteries were normal. Venous obstruction appears to have been due to external compression. The anatomical distribution and size of the affected segments are compatible with compression of two loops of jejunum against the vertebral column by a tight lap-strap seatbelt causing localised venous occlusion without arterial compromise, resulting in venous engorgement and erythrocyte extravasation facilitated by the patient’s anticoagulation. The mucosa was largely intact, confirming the acute nature of the injury, and consistent with presentation immediately after a long flight. Non-traumatic seat-belt injury should be considered in patients
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