Abstract
Traumatic visceral arteriovenous fistulae are rare and pose a diagnostic and therapeutic challenge. We present the case of a 20-year-old male who sustained multiple gunshot wounds to the abdomen, injuring the inferior vena cava, duodenum, stomach, and small bowel. The patient was taken emergently to the operating room for repair of his injuries, which required primary small bowel repair, duodenal repair, and inferior vena cava ligation due to exigent hemorrhage. At the initial operation there was a normal pulse in the superior mesenteric artery at the base of the small bowel mesentery, with no evidence of hematoma or thrill in the small bowel mesentery. The patient was subsequently returned to the operating room several times for bowel exploration and abdominal wall closure with mesh. Ten days after his initial injury, the patient was noted to have an abdominal bruit on physical exam. Arteriography demonstrated a fistula between the proximal superior mesenteric artery and vein with significant portal hypertension. The patient underwent surgical repair of the superior mesenteric artery and vein with closure of the fistula. The patient had no further complications and was discharged from the hospital 1 month later, after abdominal wall skin grafting, in good condition. The patient remains in good health 12 months later. Continued vigilance and careful physical examination are important in the identification of delayed vascular injuries and allow timely treatment and avoidance of untoward long-term sequelae.
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References
Asensio J, Forno W, Roldan G, et al. Visceral vascular injuries. Surg. Clin. North Am 2002;82:1-20
Asensio Asensio J, Berne J, Santiago C, et al. Traumatic injury to the superior mesenteric artery. Am. J. Surg. 1999;178:235-239
Asensio J, Britt L, Borzotta A, et al. Multiinstitutional experience with the management of superior mesenteric artery injuries. J. Am. Coll. Surg. 2001;193:354-365
Shih F, Sy-jau W, Keh-jong D, et al. Successful management of traumatic mesenteric arteriovenous fistula after failure of steel coil embolization: case report. J. Trauma 1994;37:682-686
Diehl J, Edwin B. Arteriovenous fistulas of the mesenteric vessels. Report of a case and review of the literature. J. Cardiovasc. Surg. 1982;23:334-337
Desai S, Modhe J, Baldev A, et al. Percutaneous transcatheter steel-coil embolization of a large proximal post-traumatic superior mesenteric arteriovenous fistula. J. Trauma 1987;27:587-588
Radonic V, Baric D, Petricevic D, et al. Advances in diagnostics and successful repair of proximal posttraumatic superior mesenteric arteriovenous fistula. J. Trauma 1995;38:305-312
Accola K, Feliciano D, Kenneth M, et al. Management of injuries to the superior mesenteric artery. J. Trauma 1986;26:313-319
Asensio J, Santiago C, Hanpeter D, et al. Operative management and outcome of 302 abdominal vascular injuries. Am. J. Surg. 2000;180:528-533
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Presented at the Twenty-second Annual Meeting of the Southern California Vasuclar Surgery Society, La Jolla, CA, April 30-May 2, 2004.
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DO, J.C., Jr., A.AZ., Teruya, T. et al. Delayed Development of a Traumatic Superior Mesenteric Arteriovenous Fistula Following Multiple Gunshot Wounds to the Abdomen. Ann Vasc Surg 19, 470–473 (2005). https://doi.org/10.1007/s10016-005-4654-1
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DOI: https://doi.org/10.1007/s10016-005-4654-1