Outcome from Traumatic Injury of the Portal and Superior Mesenteric Veins

Abstract

Traumatic injuries to the portal vein (PV) and superior mesenteric vein (SMV) are rare and carry a high mortality rate, and the best approach and method of repair is still subject to debate. The objective of the present study was to analyze risk factors for mortality in portal and superior mesenteric venous injuries. A retrospective analysis of 18 patients during a 5-year period was performed. Mechanism of injury, shock upon admission, Revised Trauma Score (RTS), Injury Severity Score (ISS), intraoperative fluid requirements, classification of venous injury severity, and associated injuries were analyzed as potential predictors of outcome. All patients were male, 9 were victims of gunshot wounds, and 11 were in shock at the time of admission. Eight patients sustained PV, and 12 sustained SMV injuries. The great majority of patients had more than 1 associated injury and 61% had an associated vascular injury. Mortality rate correlated with injury severity. Overall mortality rate was 72%. Nonsurvivors had higher ISS than survivors (24 +/-0.4 and 20 +/-1.7, respectively; p = 0.006). Uncontrollable intraoperative hemorrhage was the cause of death in 5 of 13 patients (38.4%). Six patients died during the postoperative period from complications of prolonged shock and multiple organ failure, and 2 died of sepsis. The physiologic status upon admission, the number of associated injuries, and the severity of the vascular injury are the most important factors related to mortality in PV and SMV injuries.

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.…”

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

“…Wiencek and Wilson 8 reported and 87% mortality rate for patients with a systolic blood pressure of <70 mmHg on arrival in the operating room. Coimbra et al 9 recently reviewed the cases of 18 patients with traumatic injuries to the portal vein (n = 8) or SMV vein (n = 12). Most of these patients had more than one associated injury and 61% had an associated vascular injury.…”

Delayed reconstruction of the superior mesenteric vein with autogenous femoral vein

“…Reported patients have associated abdominal injuries in the following decreasing order: liver, inferior vena cava, kidney, spleen, superior mesenteric artery, stomach, small bowel, colon, duodenum, and pancreas. 3,6 Outcome depends on the degree of associated trauma, not on the SMV injury per se.…”

“…[6][7][8]10 The decision to repair is usually based on the degree of injury and the condition of the patient. 11 In the present case, damage control laparotomy was necessary due to extensive blood loss and coagulopathy.…”

“…5 Following ligation, most patients will develop some degree of bowel edema due to venous congestion, but nearly all will resolve the edema after several days due to development of abundant collateral flow. [6][7][8] More than 500 cases of SMV injury have been reported in the literature, but there have only been five reports of initial SMV bypass for acute mesenteric venous obstruction. 3 The remainder underwent ligation or primary repair of the SMV.…”