A Challenge in the Treatment of An Injury to the Superior Mesenteric Artery and Vein

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 38; no. 4; pp. 609 - 615
• Main Authors: Nakayama, Fumihiko, Yamamoto, Mariko, Yasumatsu, Hiroshi, Sakamoto, Taigo, Matsumoto, Hisashi, Mashiko, Kazuki
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 31.05.2018; 日本腹部救急医学会
• Subjects: ダメージコントロール手術; 上腸間膜動脈損傷; 上腸間膜静脈損傷; 外傷外科
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.38.609

It is rare for any injury to occur to the superior mesenteric artery (SMA) and/or superior mesenteric vein (SMV). Occasionally, however, such injuries cause severe hemorrhagic shock. In 6,084 trauma victims treated in our institute during the six years from 2011, there were 52 SMA/V injuries (0.85％, 50 cases due to blunt injury, 2 cases due to penetrating injury) requiring a hemostatic laparotomy. In 26 cases (24 cases due to blunt trauma), injuries were found in the more proximal zone (classification by Fullen Zone I to Ⅲ) and required a surgical approach for the vessels. All SMA injuries were ligated to control bleeding, and SMV injuries were repaired as much as possible. Subsequently, a survival rate of 76.9％ could be obtained after 6 years. Although cardiac arrest is often imminent due to the massive bleeding caused by SMA/V injury, controlling hemorrhage and avoiding intestinal ischemia should be promptly and accurately performed, even in those circumstances under which is difficult to approach the injured site accompanied with a large amount of blood outflow. Accordingly, our treatment tactics is thought to be appropriate in these series.