Iatrogenic superior mesenteric vein injury: the perils of high ligation

Abstract

Iatrogenic superior mesenteric vein injury is a rare, severe, and underreported complication of both open and laparoscopic right colectomy for colonic adenocarcinoma. We identified several mechanisms of injury such as anatomic misperception, excessive traction and pulling on the venous system, extensive tumor involvement of the mesentery, and uncontrolled suturing attempts at hemostasis. We believe that increased awareness of this complication with profound understanding of vascular anatomy and the different mechanisms of injury will allow surgeons to avoid this often devastating complication.

Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis

“…Freund et al . described five cases (1.6%) of SMV injuries from a total of 304 radical right colectomies 73 . Only two of these injuries were observed during the initial surgery, and three patients required saphenous graft reconstruction, with one postoperative death 73 .…”

Safety, quality and effect of complete mesocolic excision vs non‐complete mesocolic excision in patients with colon cancer: a systemic review and meta‐analysis

“…Freund et al . reported a total iatrogenic superior mesenteric vein injury rate of 1.6% (5/304) when performing central ligation in right‐sided colon cancer. Bertelsen et al .…”

“…Some possible mechanisms of superior mesenteric vein injury include anatomic variations and avulsion of the middle colic vein due to excessive traction. Freund et al [29] reported a total iatrogenic superior mesenteric vein injury rate of 1.6% (5/304) when performing central ligation in right-sided colon cancer. Bertelsen et al [22] reported a higher rate of intra-operative injury to organs including injury to the superior mesenteric vein, splenic injury and injury to other segments of the colon in CME than in NCME (9.1% vs 3.6%, P < 0.001).…”

Robotische Hemikolektomie rechts mit kompletter mesokolischer Exzision (CME): Das suprapubische Bottom-to-up-Prinzip mit fluoreszenzangiografiegesteuerter Darmtranssektion und intrakorporaler Ileotransversostomie – eine Videovignette

“…Dies kann das bekannte Risiko von iatrogenen Gefäßverletzungen bei der CME bzw. ZGL reduzieren [12]. Dies wirkt sich insbesondere bei adipösen Patienten aus, bei denen es intraperitoneal regelhaft erschwert ist, die ileokolischen Gefäße in toto anzuspannen, wie es beim klassischen medial-zu-lateralen Ansatz zum Freilegen des Mesocolon ascendens im Rahmen der CME üblich ist.…”