Mesenteric involvement in acute traumatic brain injury: a narrative review of limited evidence and research gaps

Traumatic brain injury (TBI) is the most important cause of morbidity and mortality around the globe.Recent advances in understanding intracranial pathophysiology and extracranial systemic factors, including the gut-brain axis and mesenteric involvement, suggest a possible but not yet clinically validated role in patient outcomes, although clinical evidence remains limited.The mesentery is a continuous organ composed of connective tissue, vasculature, lymphatics, and immune cells, and has been the centre of attraction in recent years for its influence on systemic inflammation, metabolic regulation, and immune response.This review explores the hypothesized involvement of the mesentery in acute traumatic brain injury, emphasizing its proposed role in neuroinflammatory pathways, gut barrier dysfunction, mesenteric ischemia, and secondary injury mechanisms.In addition to the above, the focus is also on the discussion of the theoretical therapeutic implications of mesenteric modulation in traumatic brain injury management and identifies key research gaps requiring future validation.Given the limited clinical evidence, these findings should be interpreted as hypothesis-generating.