title: Traumatic Injury of the Superior Mesenteric Vein: Ligate, Repair or Shunt?
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.
authors.affiliation: Department of Surgery, Foothills Medical Centre, Calgary, AB, Canada.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: Department of Surgery, Foothills Medical Centre, Calgary, AB, Canada.|Department of Critical Care Medicine, Foothills Medical Centre, Calgary, AB, Canada.|Department of Trauma Program, Foothills Medical Centre, Calgary, AB, Canada.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.affiliation: Department of Vascular Surgery, Peter Lougheed Hospital, Calgary, AB, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Smith
authors.affiliation: Department of Surgery, Foothills Medical Centre, Calgary, AB, Canada.|Department of Trauma Program, Foothills Medical Centre, Calgary, AB, Canada.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Mulloy
authors.affiliation: Department of Vascular Surgery, Peter Lougheed Hospital, Calgary, AB, Canada.
authors.forename: Leonard
authors.initials: L
authors.lastname: Tse
authors.affiliation: Department of Surgery, Foothills Medical Centre, Calgary, AB, Canada. cgball@ucalgary.ca.|Department of Trauma Program, Foothills Medical Centre, Calgary, AB, Canada. cgball@ucalgary.ca.|Foothills Medical Centre, Room EG23, 1403-29 Street NW, Calgary, Alberta, Canada T2N 2T9. cgball@ucalgary.ca.
authors.forename: Ian B
authors.initials: IB
authors.lastname: Anderson
keywords: Injury; Shunt; Superior mesenteric vein