Superior mesenteric vein injury in penetrating abdominal trauma: A case report

Abstract

Introduction: Injury to the superior mesenteric vein (SMV) is considerably rare amongst abdominal visceral vascular injuries. Multiple factors play a role in identifying such injuries, leading to the high morbidity and mortality associated.

Case presentation: We report a twenty-six-year-old male sustaining a SMV injury following a self-inflected gun shot. Initial assessment of the patient reveals hemodynamic instability and intraabdominal hemorrhage. Surgically approaching the patient was performed in two stages. Midline laparotomy was performed to control the active bleeding and stabilize the patient. Kocherizing the duodenum reveals that the source of retroperitoneal bleeding was from the SMV and one of the supra-renal tributaries of the Inferior Vena Cava (IVC). Several stitches were taken in a figure-of-eight manner to control the bleeding. Second-look operation was performed to rule out other injuries and permeant closure of the abdominal wall. Proper psychiatric care was ensured before transferal of the patient in good conditions to another healthcare facility specialized in mental health.

Discussion: High mortality rates reaching up to 65% are reported in similar cases. Multiple factors have contributed to the patient's favorable outcome, including rapid trauma response, absences of other associated injuries, and the patient's baseline healthy status.

Conclusion: The principle of damage control surgery in trauma is an effective strategy to stabilize the patient and rule out other injuries which might not have been discernible initially.

Keywords: Abdominal vascular injury; Care report; Gunshot; Inferior vena cava; Trauma; superior mesenteric vein.

Fig. 1

Basic anatomy of the portosystemic circulation. Red circle delineates the site of injury.

Fig. 2

Repairing the SMV injury while applying proximal and distal pressure. White arrow points at the SMV injury. Yellow arrow points at the fourth part of the duodenum.

Fig. 3

White arrow points at the SMV after repair. Yellow arrow points at the duodenum. Blue arrow points at the transverse colon.

Fig. 4

White arrow points at the pocket of pellets found in the retroperitoneum next to the aorta. Yellow arrow points at the duodenojejunal junction. Blue arrow points at the jejunum.