Traumatic superior mesenteric arteriovenous fistula: Report of a case and review of the literature

Abstract

Penetrating arterial injuries can result in the formation of a traumatic false aneurysm or an arteriovenous fistula. Traumatic arteriovenous fistulas of the mesenteric circulation are extremely rare, with only 15 operated cases reported in the English language literature that involved the superior mesenteric artery and vein. Although surgical intervention has been considered the most successful method to treat traumatic mesenteric arteriovenous fistulas, percutaneous transcatheter embolization has been occasionally advocated in the management of small iatrogenic fistulas. We report a case of a gunshot wound patient who had an 8 cm abdominal aortic false aneurysm, as well as a high-flow arteriovenous communication between the superior mesenteric artery and vein, which were successfully treated by a combination of aorto-superior mesenteric bypass and postoperative percutaneous transcatheter embolization. A review of the literature is also included.

Superior Mesenteric Arteriovenous Fistula

“…Abdominal bruits have been appreciated in some patients due to turbulent flow through the fistula. 4 –7 In less than 1 year, our patient began to develop signs of significant portal hypertension. These included ascites requiring frequent paracentesis, a large right pleural effusion necessitating thoracentesis, variceal development, and an episode of hematochezia.…”

“…Fistula formation between the superior mesenteric artery and vein is rare and is most often encountered in patients with a history of penetrating abdominal trauma or surgery. 1 –10 The most common iatrogenic causes include prior bowel resection and pancreatic surgery. 1 Prior vascular surgery has also been reported.…”

Traumatic Superior Mesenteric Arteriovenous Fistula and Aortic Pseudoaneurysm 20 Years after Repair

“…In August 1984, a 16-year-old youth was shot twice at close range with a 0.32-caliber handgun. 1 When asked what happened, he stated, “I brought a knife to a gun fight.” In a rural Georgia hospital, the patient underwent emergency exploratory laparotomy with repair of an “aortic bullet wound” and left nephrectomy. Twenty-one days after this operation, the patient returned to his local hospital complaining of severe abdominal pain and shortness of breath.…”

“…A 1984 case report described a 16-year-old youth who experienced gunshot wounds of the abdomen that resulted in a superior mesenteric arteriovenous fistula (SMAVF) and an aortic pseudoaneurysm, which were successfully treated by a combination of operative and endovascular techniques. 1 In this report, we review his treatment in 1984, the current treatment options, and a rare complication from his operation 20 years previously.…”

Superior mesenteric arteriovenous fistula embolisation complicated by bowel ischaemia

“…Such fistulas usually involve the hepatic or splenic arteries with a death rate, in untreated cases, that can reach approximately 25% 1. Arterioportal fistulas involving the superior mesenteric circulation are quite uncommon and are frequently observed in patients who have sustained major abdominal traumas or iatrogenic injuries during bowel resection 2 3…”