Nadir bir olgu: Künt abdominal yaralanma sonucu geliþen izole süperiyor mezenterik ven yaralanmasý

Künt karýn travmalarýna baðlý intraabdominal vasküler yaralanmalara ender rastlanmaktadýr. Süperiyor mezenterik ven (SMV) ve portal ven yaralanmalarýnýn acil þartlarda görüntülenmesi oldukça zordur. Bu yazýda, düþük hýzlý araç içi trafik kazasýnda direksiyon simidine çarpma ile oluþan künt batýn travmasý sonucu izole SMV yaralanmasý olan hasta ve tedavi yaklaþýmýmýz sunuldu. Altmýþ iki yaþ erkek hasta acil servise giriþini takiben yapýlan muayenesinde karýnda minimal distansiyon ve yaygýn hassasiyet olduðu görüldü. Ultrasonografisinde, karýn içerisinde yaygýn mayi varlýðý ve þüpheli karaciðer yaralanmasý bildirildi. Abdominal tomografide perihepatik ve perisplenik alanlarda sývý varlýðý saptandý. Solid organ yaralanmasýnýn olmadýðý görüldü. Laparatomide ince baðýrsak mezenterinde yaralanma görüldü. SMV üzerinde splenik ven birleþimi altýnda defekti mevcuttu. Uç yan damar anastomozu ve primer onarým gerçekleþtirildi. Altý ay süreyle yapýlan takiplerinde hastanýn aktif þikâyeti olmadýðý, yapýlan tetkikler sonucunda SMV ve portal ven de patoloji olmadýðý görüldü. Hemodinamik açýdan stabil olan süperior mezenterik venöz yaralanmalarýnda tecrübeli cerrahlarca uygulanan vasküler onarým tekniklerinin kullanýlmasýnýn anatomik ve fonksiyonel bütünlüðün devamlýlýðý açýsýndan önemli olduðunu düþünmekteyiz.

A rare case: Isolated superior mesenteric vein injury occurring after blunt abdominal trauma

Intraabdominal vascular injuries due to blunt abdominal trauma are rare. It is very difficult to visualize superior mesenteric vein (SMV) and portal vein injuries under emergency conditions. In this case study, we reported a low-speed car accident, a patient with isolated SMV injury as a result of a blunt abdominal trauma that arose from a collision with a steering wheel. A 62-year-old male patient was admitted to the emergency department with minimal distention and diffuse tenderness in the abdomen. The presence of diffuse fluid in the abdomen and suspected liver injury were reported in ultrasonography. The presence of fluid in perihepatic and perisplenic areas was detected in abdominal tomography. No solid organ injury was observed. Laparotomy revealed an injury in the small intestine mesentery. There was a defect on SMV under splenic vein combination. End side vein anastomosis and primary repair were performed. During six months follow-up, the patient did not have active complaints, and there was no pathology in the SMV and portal vein. We think that the use of vascular repair techniques applied by experienced surgeons in hemodynamically stable superior mesenteric venous injuries is important concerning continuity of anatomical and functional integrity.