ESR Essentials: blunt abdominal trauma in adult patients: vascular injuries to solid organs and mesentery-practice recommendations by the European Society of Emergency Radiology.

Abstract

Blunt abdominal trauma (BAT) remains a leading cause of morbidity and mortality in trauma patients, with vascular injuries to solid organs and the mesentery posing critical challenges. These injuries can lead to life-threatening hemorrhage or ischemia if not identified and managed promptly. FAST (Focused Assisted Sonography for Trauma) represents a standard first-line bedside imaging tool in the initial triage of blunt abdominal trauma, supporting early decision-making during resuscitation and minimizing delays to treatment. In hemodynamically stable (or stabilized) patients, contrast-enhanced CT remains the reference standard for the detection and characterization of vascular injuries and for follow-up assessment. This paper aims to present the European Society of Emergency Radiology's (ESER) evidence-based recommendations for managing vascular injuries in BAT, focusing on appropriate imaging modalities, diagnostic criteria, and follow-up strategies that may help colleagues in their clinical practice. KEY POINTS: Standardized CT-based assessment pathways for blunt abdominal trauma vascular injuries are needed to reduce variability in detection, reporting, and follow-up. Contrast-enhanced CT provides the reference imaging tool in stable/stabilized patients to characterize vascular injury patterns and guide non-operative, endovascular, or surgical management. Harmonizing CT interpretation with structured reporting and follow-up strategies supports timely treatment and improves outcomes in major blunt abdominal trauma.