Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Delayed Presentation of a Post-traumatic Mesenteric Arteriovenous Fistula: A Case Report

외상 후 지연성으로 발생한 장간막 동정맥루: 증례보고

  • Cho, Jayun (Trauma Center, Kyungpook National University Hospital) ;
  • Jung, Heekyung (Department of Surgery, Kyungpook National University School of Medicine) ;
  • Kim, Hyung-Kee (Department of Surgery, Kyungpook National University School of Medicine) ;
  • Lim, Kyoung Hoon (Trauma Center, Kyungpook National University Hospital) ;
  • Chun, Jae Min (Department of Surgery, Kyungpook National University School of Medicine) ;
  • Huh, Seung (Department of Surgery, Kyungpook National University School of Medicine) ;
  • Park, Jinyoung (Trauma Center, Kyungpook National University Hospital)
  • 조자윤 (경북대학교병원 외상센터) ;
  • 정희경 (경북대학교 의학전문대학원 외과학교실) ;
  • 김형기 (경북대학교 의학전문대학원 외과학교실) ;
  • 임경훈 (경북대학교병원 외상센터) ;
  • 천재민 (경북대학교 의학전문대학원 외과학교실) ;
  • 허승 (경북대학교 의학전문대학원 외과학교실) ;
  • 박진영 (경북대학교병원 외상센터)
  • Received : 2013.08.17
  • Accepted : 2013.09.02
  • Published : 2013.09.30
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Abstract

Introduction: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare. Case Report: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA's orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month follow-up period. Conclusion: Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.

Keywords

References

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