• Masato Miyauchi, Shigeki Kushimoto, Makoto Kawai, and Hiroyuki Yokota.
• Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. m-masa@nms.ac.jp
• J Nippon Med Sch. 2011 Jan 1; 78 (2): 116-9.

AbstractTraumatic injury of the superior mesenteric vein (SMV) by blunt trauma is a rare but frequently fatal injury. Although simple ligation should be considered for a patient in unstable condition, its complications have not been reported in detail. A 47-year-old man was struck on the abdomen during a fight. When he was transferred to a local hospital, he complained of severe abdominal pain. Computed tomography (CT) of the abdomen showed fluid accumulation in the peritoneal cavity and a hematoma around the root of the mesentery, with leakage of contrast material. When the patient was transferred to our emergency department, the hemodynamic status did not improve after rapid fluid resuscitation with 1,500 mL of crystalloid. Emergency laparotomy was performed 4 hours after the injury. Two lacerations of the proximal SMV were observed. The SMV was ligated owing to the unstable hemodynamic status. On postoperative day (POD) 5, abdominal radiography showed dilated loops of bowel, suggesting ileus of the small bowel. A CT scan with contrast enhancement showed that the wall of the small bowel was thickened. On POD 11, a CT scan showed that the collateral vessels that drain the mesenteric circulation had not developed. However, collateral vessels were revealed on a 3-dimensional CT scan, and, on POD 23, a CT scan showed that the collateral vessels had developed. The patient was discharged on POD 37. This case demonstrates that simple ligation of the proximal SMV leads to the development of collateral vessels and is useful for preventing side effects and improving outcomes.

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