Traumatic Injury of the Superior Mesenteric Vein: Ligate,Repair or Shunt? |
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Authors: | Chad G. Ball Andrew W. Kirkpatrick Matthew Smith Robert H. Mulloy Leonard Tse Ian B. Anderson |
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Affiliation: | (1) Department of Surgery, Foothills Medical Centre, Calgary, AB, Canada;(2) Department of Critical Care Medicine, Foothills Medical Centre, Calgary, AB, Canada;(3) Department of Trauma Program, Foothills Medical Centre, Calgary, AB, Canada;(4) Department of Vascular Surgery, Peter Lougheed Hospital, Calgary, AB, Canada;(5) Foothills Medical Centre, Room EG23, 1403–29 Street NW, Calgary, Alberta, Canada T2N 2T9 |
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Abstract: | Abstract We report a case of SMV injury in a critically ill patient. The patient was a 19-year-old woman involved in a motor vehicle collision. Her injuries included grade II splenic and renal lacerations, devascularized and lacerated right and transverse colon, a transected transverse mesocolon, a massive shear injury of her abdominal wall, and two partial SMV transections. At initial damage control laparotomy, the SMV was ligated, the devascularized bowel resected and a temporary abdominal closure applied. At re-operation, a mesocaval shunt using saphenous vein was employed. The shunt failed and the patient required a saphenous vein jump graft. Although visceral vascular injuries are rare, ligation of the SMV in a damage control situation is acceptable. This case study is the first to discuss appropriate treatment when interruption to a patient's collateral visceral venous drainage limits the surgeon’s ability to ligate. In these situations, bypass shunts may be successful. |
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Keywords: | Superior mesenteric vein Injury Shunt |
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