Splenomesenteric bypass as revascularisation technique after iatrogenic injury of the superior mesenteric artery during radical nephrectomy: A case report

Abstract

Highlights Iatrogenic injury of the superior mesenteric artery is rare. This injury imparts a high risk of mortality due to visceral ischemia and death. An anastomosis to the splenic artery may be an easier solution than an aorto-mesenteric bypass.

Superior Mesenteric Artery Injury During Robot-assisted Laparoscopic Nephrectomy: A Robotic Nightmare

“…Injury to the SMA during abdominal surgery is rare but likely under-reported. The existing literature primarily consists of case reports and small case series [3] , [4] , [5] . It is of critical importance for robotic surgeons to identify SMA injury given the potential catastrophic consequences of inaction that may give rise to a mortality rate of 50%.…”

“…Tumour size and location are the main tumour factors that predispose to SMA injury . Left-sided, large, upper pole, medial/hilar tumours are the main predictors of SMA injury during renal surgery [5] , [10] , [14] . Large tumours are likely to lead to significant distortion of the vasculature; therefore, meticulous dissection and mobilisation of the kidney and hilum can minimise the risk of injury.…”

“…A number of other techniques have been described for use when end-to-end anastomosis is not viable [5] , [20] . Vein patches can help alleviate the risk of stenosis after repair, which is more common when vessels are sutured directly [21] .…”

“…Alternatively, retrograde grafting from the common iliac artery is an option, but both of these techniques are technically demanding. Few cases of splenectomy have been described in order to revascularise ligated aortic vessels using the splenic artery, but the splenomesenteric bypass approach should be used only on a case-by-case basis, with consideration of patient and surgical factors [5] . The collateral circulation of the SMA is poor [23] and the consequences of proximal SMA injury can be devastating, so whichever approach is employed, speed of repair remains the key factor.…”

Revascularisation of iatrogenic superior mesenteric artery injury by end to end anastomosis during robot assisted nephrectomy

“…Therefore, an iatrogenic SMA injury should be promptly repaired as was done in our case. SMA injury can be managed by saphenous vein, renal vein patch or by an end to end anastomosis as was done in our case [12,13].…”