Delayed Traumatic Superior Mesenteric Arteriovenous Fistula After a Stab Wound

Saunders, Marc S.; Riberi, A; Massullo, Edmund

doi:10.1097/00005373-199201000-00021

Cited by 16 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3,4 Fistula may develop a few days to years after trauma owing to presumed, unrecognized injury to the superior mesenteric artery at initial presentation or operation. 1,5 Although many patients with this type of fistula remain asymptomatic, 6 most reported in the literature have a delayed presentation of weight loss, nausea, vomiting, abdominal pain, ascites, diarrhea, and signs of right heart failure such as pulmonary effusions, mesenteric ischemia, or bleeding. [7][8][9][10] The most consistent symptom is abdominal bruits that can be palpated in the periumbilical or epigastric region just left of the midline with systolic accentuation on auscultation.…”

mentioning

confidence: 99%

Post-traumatic superior mesenteric arteriovenous fistula: Endovascular treatment with a covered stent

2008

Journal of Vascular Surgery

View full text Add to dashboard Cite

This case report concerns a patient who sustained multiple stab wounds causing rupture of the liver, duodenum, stomach, and pancreas. Two months after the initial injuries were repaired, the patient complained of persistent epigastric pain, vomiting, and nausea, with marked deterioration of his clinical condition. Computed tomography showed early enhancement and enlargement of the superior mesenteric vein, and selective angiography demonstrated a fistula between the superior mesenteric artery and vein. A covered stent was placed into the superior mesenteric artery, with complete closure of the fistula. The patient was discharged with complete resolution of the symptoms and full general physical recovery after stent placement.

show abstract

mentioning

confidence: 99%

Post-traumatic superior mesenteric arteriovenous fistula: Endovascular treatment with a covered stent

2008

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…Late hemorrhage after trauma may be explained by a weakened arterial media resulting in a subsequent delayed dissection and rupture [162]. Post-traumatic superior mesenteric artery (SMA) arteriovenous fistulae, commonly observed after penetrating trauma but also after blunt injury or following primary surgical repair, may be occult for a prolonged period [163,164]. Early recognition and treatment of this lesion is mandatory to avoid subsequent major complications such as bowel ischemia, venous congestion, intraperitoneal rupture, or secondary portal hypertension [163,165,166].…”

Section: Mesenteric Arterymentioning

confidence: 99%

“…Early recognition and treatment of this lesion is mandatory to avoid subsequent major complications such as bowel ischemia, venous congestion, intraperitoneal rupture, or secondary portal hypertension [163,165,166]. In cases of large, proximal, or long-duration fistula, signs of right cardiac failure may also be present [164]. Any clinical suspicion, such as an abdominal bruit or palpable thrill, should require a selective arteriography delineating the mesenteric and portal circulation, localizing the fistula and allowing an elective planed surgical or endovascular approach.…”

Section: Mesenteric Arterymentioning

confidence: 99%

“…The follow-up was uneventful closure has been described [167], a mortality of 25-35% is reported for untreated traumatic mesenteric arteriovenous fistulae. Surgical therapeutic options, including ligation of both arterial and venous sides or fistula resection with arterial and venous reconstruction by saphenous vein or synthetic interposition grafting [164], carry an operative mortality rate from 18 to 28% [166]. Several studies have shown that percutaneous embolization is a safe, reliable, and effective alternative with a low complication rate compared with surgery [162,163].…”

Section: Mesenteric Arterymentioning

confidence: 99%

See 1 more Smart Citation

Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention)

Goffette

Laterre

2002

Eur Radiol

View full text Add to dashboard Cite

The nonoperative management (NOM) of abdominal trauma has gained increasing acceptance over the past decade. This approach has been extended to severe trauma patients previously considered as candidates for surgery. Consequently, the incidence of delayed and uncommonly encountered complications has increased. Causes of delayed complications are multiple and include: (a) abnormal or insufficient injury healing process; (b) retention of necrotic tissue; (c) secondary infection of initially sterile collections; and (d) underestimation of injury severity. The purpose of this review article is to explain the role of various imaging modalities in detecting post-traumatic delayed complications and to highlight the usefulness of minimally invasive techniques, including laparoscopy, biliary endoscopy, therapeutic angiography and image-guided drainage. Subsequent complications, which do not necessarily negatively influence the final outcome, are often predictable, virtually obligatory consequences of the successful NOM of high-grade or complex abdominal injuries. Between 50 and 60% of those patients with grade-IV or grade-V liver or splenic lacerations require some type of interventional treatment; therefore, indiscriminate discharge of patients with solid organ injury managed conservatively may be potentially harmful. As the incidence of complications is higher for more severe grade-IV or grade-V liver, spleen, or kidney injuries, scheduled follow-up CT scans may be rational in this subset of patients to identify potential complications amenable to early application of interventional techniques. Follow-up CT scans are unnecessary in stable adults or children with low-grade injury. Delayed splenic or hepatic rupture is one of the major concerns because this type of complication remains difficult to predict and historically often requires emergent surgery. These ruptures may benefit from NOM, should the same criteria as for primary rupture be respected. Conversely, parenchymatous focal pooling of contrast on initial CT is a good predictor for the development of delayed vascular malformation. In children, as a large part of splenic and hepatic vascular malformations resolve spontaneously, expectant observation may be indicated provided that a strict imaging follow-up is performed until complete disappearance of these lesions. If needed, embolization of parenchymal vascular lesions should be performed as selectively as possible in order to avoid functional parenchyma loss and to reduce the risk of secondary infection of hematoma or ischemic tissue. Technical improvements, such as microcatheter systems and direct percutaneous approach to targeted lesions, have widened the potential for safe endovascular management of acquired vascular malformations. Advantages and disadvantages relative to the different embolic agents are explained. Endoscopic retrograde pancreatography is the chief investigational tool for detecting biliary and pancreatic ducts injuries. The respective roles of endoscopic, percutaneous and surgical approaches...

show abstract

“…Patients may survive due to the protective effect of the fistula in l~reventing free hemorrhage and hematoma formation, as arterial blood loss passes directly into the low pressure venous channels [10]. Unless discovered at initial laparotomy, a superior mesenteric arteriovenous fistula may form, presenting even several months later with abdominal pain, diarrhea, or an abdominal bruit or thrill [13]. In acute combined injuries, the repair of the SMV is important in order to avoid impaired outflow for arterial reconstruction, increasing likelihood of thrombosis, accentuation of intestinal ischemic changes by induced hyperemia of the mid-gut, and hypovolemia incurred as a consequence of intestinal pooling [6].…”

Section: Combined Arterial and Venous Injurymentioning

confidence: 99%