Isolated superior mesenteric vein injury from blunt abdominal trauma:: Report of a case

Solitary injury of the superior mesenteric vein (SMV) after blunt abdominal trauma is a rare but frequently fatal injury. A 63-year-old man was admitted to our hospital after falling on his right side from a height of 5 m. Computed tomography (CT) showed blood in the peritoneal cavity, but no liver or spleen injury. Emergency laparotomy revealed complete disruption of the SMV across the site of confluence with the splenic vein. We performed primary reconstruction by connecting both ends of the vein as an end-to-end anastomosis. Following restoration of gastrointestinal passage the patient was discharged in good health. At his 6-month follow-up, angio-CT showed an unobstructed SMV and portal vein. There was slight stenosis at the site of the suture and no sign of development of collateral venous circulation into the liver. This case report shows that primary repair of an SMV injury can be done in a stable patient without concomitant life-threatening injuries once proximal and distal control of bleeding has been achieved. Ligation should be reserved for patients with multiple injuries and an unstable condition.