Traumatic Injury of the Proximal Superior Mesenteric Artery

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Abstract
Injuries of the proximal superior mesenteric artery (SMA) are relatively uncommon and extremely perplexing lesions. Consecutive patients (15) with this injury, 13 injuries from gunshot wounds and 2 from blunt trauma were treated. Associated lesions and massive blood loss were common, averaging 3.6 injuries and 4800 ml per patient, respectively. Methods of SMA repair include lateral arteriorrhaphy (11 patients), primary reanastomosis (3 patients) and saphenous vein grafts (1 patient). Of 3 patients whose injuries included segmental loss of the SMA that required a primary end-to-end anastomosis, 2 suffered subsequent thrombosis. Second-look operations were performed in 5 patients, with 2 of these requiring a further reconstructive procedure. The only late death occurred in a patient with a severe head injury and a failure of his SMA repair, which potentially could have been prevented by a 2nd-look procedure. There were 5 deaths (33%), with 4 occurring from acute hemorrhages and 1 late death occurring following intestinal necrosis and sepsis. Malabsorption or other late intestinal complications did not occur. Proximal SMA lesions evidently must be repaired but primary anastomosis to repair arterial defects is associated with a high failure rate. The 2nd-look operation is a useful adjunct in improving survival in these patients.