Isolated Superior Mesenteric Vein Injury from Blunt Abdominal Trauma: Report of a Case

Abstract

Solitary injury of the superior mesenteric vein (SMV) after blunt abdominal trauma is a rare but frequently fatal injury. A 63-year-old man was admitted to our hospital after falling on his right side from a height of 5 m. Computed tomography (CT) showed blood in the peritoneal cavity, but no liver or spleen injury. Emergency laparotomy revealed complete disruption of the SMV across the site of confluence with the splenic vein. We performed primary reconstruction by connecting both ends of the vein as an end-to-end anastomosis. Following restoration of gastrointestinal passage the patient was discharged in good health. At his 6-month follow-up, angio-CT showed an unobstructed SMV and portal vein. There was slight stenosis at the site of the suture and no sign of development of collateral venous circulation into the liver. This case report shows that primary repair of an SMV injury can be done in a stable patient without concomitant life-threatening injuries once proximal and distal control of bleeding has been achieved. Ligation should be reserved for patients with multiple injuries and an unstable condition.

Trauma to the Superior Mesenteric Artery and Superior Mesenteric Vein: A Narrative Review of Rare but Lethal Injuries

“…Debate exists regarding whether repair or ligation should be performed for SMV injuries. There is some concern about bowel viability following ligation; however, there is collateral flow within the portal system via the IMV and portosystemic branches, mainly the retroperitoneal perforators of Retzius; thus, ligation of the SMV is typically tolerated [59, 60]. Ligation has become a more acceptable option over the past several decades.…”

“…scans may establish the diagnosis preoperatively; however, in patients presenting with hemoperitoneum, immediate exploratory laparotomy is warranted [59].…”

Traumatic Injury of the Superior Mesenteric Vein: Ligate, Repair or Shunt?

“…Taken as a whole, the literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] now recognizes that in a hemodynamically stable, single system injured patient, the SMV injury can be repaired via venorrhaphy. In a damage control situation however, arresting hemorrhage and returning the patient to the ICU for physiologic stabilization is of paramount importance.…”

A Rare Case: Isolated Superior Mesenteric Vein Injury Occuring After Blunt Abdominal Truma

“…The selection of vessel repair methods in mesenteric vein injuries would be more appropriate concerning anatomic and functional considerations, although these methods come with technical difficulties. Kostka et al [9] reported on a patient who was treated with end-to-end anastomosis and who suffered no additional problems in the follow-up period. In the same patient, the gastrointestinal passage returned to normal at postoperative day 9, and the patient was discharged on day 20.…”