The gastrocolic v. or Henle's gastrocolic trunk was described in 1868 [9]. We suggest defining this vein as the confluence of the right gastroepiploic and right upper colic vv. We report two original cases of avulsion of the gastrocolic v. occurring during a blunt abdominal trauma. The aim of this paper is a description, based on the literature, of the anatomy of the gastrocolic v. in order to precise the lesional mechanism. The gastrocolic v. is present in 70% of individuals. It is short (less than 25 mm) but of major calibre (3 to 10 mm). The gastrocolic v. is situated close beneath the root of the transverse mesocolon, and travels along the anterior surface of the head of the pancreas. Anatomic variations are detailed and a meta-analysis of interpretable studies was made. Both the supra- and infra-mesocolic surgical approaches are described. The radiologic and surgical importance of the gastrocolic v. is discussed. The lesional mechanism in both our cases of injury of the gastrocolic v. is explained.

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We read with interest the article published in a recent issue of Pediatric Critical Care Medicine by Gossiome et al (1). This work aims to describe the prehospital administration of tranexamic acid (TXA) by mobile medical teams (MMTs) in major pediatric trauma. The findings of the study raise three important questions for us. In France, specialist pediatric MMTs are rare and often limited to one or two per geographical area; such teams are composed of both an emergency physician and nurse with specialist training in pediatrics. Hence, in general, the most common MMTs are not specialized in pediatrics but are called upon to take care of children in the absence of an available or existing pediatric MMTs. Therefore, first, we wondered whether Gossiome et al (1) knew the type of MMT (i.e., pediatric or nonpediatric) that dealt with their cases of pediatric trauma. This information would allow us to compare practices of the two types of MMT. Indeed, at present, TXA is widely used in the care of adults with trauma, but not so in pediatrics. We could thus see whether emergency physicians who regularly use TXA in adults are also more likely to prescribe TXA in children (or the opposite in the absence of pediatric recommendations).Second, regarding the indication for TXA, did Gossiome et al (1) consider the presence of an effusion-as identified by prehospital focused assessment with trauma sonography (FAST)-as a criterion for the appropriateness of using TXA? We note that only 40% of children had a FAST examination, and, in particular, only 34.4% of cases not receiving TXA had a FAST examination. As it stands, there is a risk of misclassifying TXA administration as appropriate or not appropriate. Do the authors know the reasoning behind lack of a FAST examination in their cohort? For example, availability of ultrasound devices in the MMT, or too low a severity of trauma in individual cases (the group of patients who did not receive TXA had a median Injury Severity Score of 6), or lack of training using the FAST examination in children. We think this information would help to better understand the prehospital administrations of TXA.Finally, Gossiome et al (1) concluded that "TXA is used in one third of patients despite the lack of high-level evidence in severely injured children, " suggesting that the use of TXA in major pediatric trauma should perhaps not be so high. As the authors state, there are no large studies proving the benefits of TXA administration in major pediatric trauma. Even so, we do know that TXA is safe at very high doses in children (2), it is effective in limiting total blood loss in pediatric cardiac surgery (3), and it reduces risk of death in adults with bleeding in the context of trauma (4). These observations may be sufficient to consider the use of TXA in major pediatric trauma. Therefore, we wanted to ask the authors their opinion, in the light of their work, as to whether or not

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