Korean J Crit Care Med.  2015 Nov;30(4):354-357. 10.4266/kjccm.2015.30.4.354.

Endovascular Treatment of Proximal Superior Mesenteric Artery Pseudoaneurysm after Stab Injury

• Kim DH
• Kim YW
• Park KB

• KMID: 2156194
• DOI: http://doi.org/10.4266/kjccm.2015.30.4.354

Abstract

Superior mesenteric artery (SMA) injuries remain a challenge to most trauma surgeons and continue to result in significant mortality despite aggressive management. We report successful management of a proximal SMA injury through endovascular treatment in a 56-year-old man. The patient presented with hypotension due to a stab wound after the epigastrium. He underwent emergency laparotomy and repair of the penetrated wall of the stomach. Right retroperitoneal hematoma at the initial laparotomy expanded and ruptured, requiring a massive transfusion. At the second laparotomy, we performed lateral arteriorrhaphy of the proximal SMA. Follow-up abdominal computed tomography angiography on post-injury day 7 showed a pseudoaneurysm on the left side of the SMA trunk. The patient was treated successfully with an endovascular stent graft.

Keyword

endovascular procedure; superior mesenteric artery; trauma

MeSH Terms

Aneurysm, False*
Angiography
Blood Vessel Prosthesis
Emergencies
Endovascular Procedures
Follow-Up Studies
Hematoma
Humans
Hypotension
Laparotomy
Mesenteric Artery, Superior*
Middle Aged
Mortality
Stomach
Wounds, Stab

Figure

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  Fig. 1. Abdominal computed tomography angiography on post-injury day 7 showed an unruptured pseudoaneurysm (white arrow) of the anterior wall of the superior mesenteric artery trunk just proximal to the inferior pancreaticodudoneal artery.

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  Fig. 2. Superior mesenteric artery (SMA) angiogram revealed a covered stent placed in the proximal SMA covering the pseudoaneurysm.

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  Fig. 3. Follow-up computed tomography angiography one month after percutaneous endovascular treatment showed the patentcovered stent of the superior mesenteric artery and the excluded pseudoaneurysm.

Reference

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