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. 2019:63:40-43.
doi: 10.1016/j.ijscr.2019.09.007. Epub 2019 Sep 19.

Revascularisation of iatrogenic superior mesenteric artery injury by end to end anastomosis during robot assisted nephrectomy

Sunil Kumar  1 , Shiv C Navariya  2 , Deepak P Bhirud  3 , Satish K Ranjan  4 , Ankur Mittal  5 , Kim J Mammen  6
Affiliations

Revascularisation of iatrogenic superior mesenteric artery injury by end to end anastomosis during robot assisted nephrectomy

Sunil Kumar et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Superior mesenteric artery (SMA) injury is very peculiar to left sided renal surgery. Although it is rare only, most of it is unreported. We report a case of SMA injury during robot assisted laparoscopic nephrectomy, which was managed successfully by end to end anastomosis.

Case presentation: A 19-year-old male patient was undergoing robot assisted laparoscopic simple nephrectomy for pyelonephritic kidney. Because of dense adhesion, SMA was inadvertently clipped and cut. It was recognised intraoperatively and an end to end anastomosis was done by laparotomy.

Discussion: SMA injury is rarely encountered in surgical practice. Most of it occurs following trauma. Iatrogenic SMA injury occurs in case of distorted local anatomy either due to adhesion or bulky tumor in left renal fossa and vicinity.

Conclusion: One should be cautious about proximity of SMA and its possible injury during left nephrectomy and it should be repaired as soon as possible.

Keywords: End to end anastomosis; Robot assisted laparoscopic nephrectomy; Superior mesenteric artery injury.

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Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
Left, contrast enhanced CT showing hypodense middle and lower pole renal parenchyma. Right, pelvicalyceal system corresponding to middle and lower pole kidney not communicating with ureter.
Fig. 2
Fig. 2
Left, arterial phase of CECT showing renal and superior mesenteric artery, Right, reconstructed angiogram showing close relationship of superior mesenteric artery and left renal artery.
Fig. 3
Fig. 3
Nephrectomy specimen showing pyelonephritic changes in mid and lower pole.
Fig. 4
Fig. 4
End-to-end anastomosis of superior mesenteric artery.
See this image and copyright information in PMC

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