Superior Mesenteric Venous Injuries: To Ligate or to Repair Remains the Question

Abstract

SMV injuries are highly lethal. Multiple associated vessel injuries increase mortality. Mortality correlates well with the American Association for the Surgery of Trauma-Organ Injury Scale for abdominal vascular injuries. Patients undergoing primary repair have higher survival rates (63%) and lesser numbers of associated vascular and nonvascular injuries; whereas those undergoing ligation have a smaller survival rate (40%) and higher number of associated vascular and nonvascular injuries. Ligation appears to be safe and should be selected for hemodynamically unstable patients with a large number of associated injuries.

Surgical Damage Control and Temporary Vascular Shunts

“…Expectedly, ligation resulted in significant bowel edema and venous engorgement with potential for splanchnic hypertension syndrome and bowel necrosis. 44 Additional reports of portal venous injuries also recommend venorrhaphy when possible, although ligation was also described and noted to be consistent with subsequent survival likely resulting from venous collateralization. [45][46][47] There is a paucity of research with regard…”

Vascular Injuries in the Abdomen

“…As with portal vein ligation, life-saving treatment by ligation of the SMV may lead to venous gangrene of the bowel highlighting the importance of aggressive resuscitation and a second-look operation. In one retrospective study of 51 patients with SMV injury, 59 % underwent ligation and 31 % underwent primary repair, while 10 % died before any defi nitive repair could be achieved [ 35 ]. Survival was 47 % overall and 53 % with isolated SMV injury, with the majority of mortalities occurring in the operating room.…”

MDCT of complications and common postoperative findings following penetrating torso trauma

“…Risk factors for abdominal compartment syndrome after penetrating trauma include massive volume replacement [8,30]; mesenteric arterial and venous ligation [8,53,54]; reperfusion of bowel [9]; hemoperitoneum and retroperitoneal hematoma; bile leaks, abscesses, and peritonitis; and increased central venous pressure from right heart failure. Compartment syndrome requires a high index of suspicion [30], and the decision to perform decompressive laparotomy may depend on a number of factors including CT findings, tense abdomen, increased compartment pressures measured with a bladder catheter, and rising lactate levels.…”