Traumatic injury to the proximal superior mesenteric vessels.

Twenty-one patients were treated for 25 injuries to the proximal superior mesenteric vessels (eight, superior mesenteric artery; nine, superior mesenteric vein; four, superior mesenteric artery plus superior mesenteric vein). Mechanisms of injury were stab wounds (11 cases), motor vehicle accidents (9 cases), and iatrogenic (one case). Ten patients (48%) arrived at the emergency room in shock (two with no obtainable case blood pressure). Superior mesenteric artery repair was performed by lateral suture (seven cases), end-to-end anastomosis (three cases), autogenous vein graft (one case), and no repair (one case). All 13 venous injuries were repaired by lateral suture. Four patients (19%) died in the operating room secondary to acute blood loss and irreversible shock. There were no late deaths and no second-look operations. Further improvement in survival depends on rapid transportation from injury site to operating room.