Proximal superior mesenteric arterial and venous injuries

In a review of more than 1000 patients with operatively managed abdominal trauma, eight patients with injuries to the proximal parts of the superior mesenteric artery or vein were identified: three with either a superior mesenteric artery or vein injury and two with combined superior mesenteric vessel injuries. All patients were in shock on arrival, and had associated abdominal injuries. All six patients with solitary superior mesenteric artery or vein injuries underwent lateral suture repair of the injured vessel with good results. The combined injuries of both of the superior mesenteric vessels required more complex types of vascular repairs: an interposition saphenous vein graft for the arterial injury and ligation of the vein in one patient who later died of bowel necrosis, and an end-to-end arterial repair and lateral venorrhaphy in the other who had a viable bowel at a second look operation. The overall mortality rate was 13%. The various management options and guidelines for injuries to the proximal parts of the superior mesenteric vessels are discussed.