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KMID : 0360720130260030248
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Journal of the Korean Society Traumatology
2013 Volume.26 No. 3 p.248 ~ p.251
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Delayed Presentation of a Post-traumatic Mesenteric Arteriovenous Fistula: A Case Report
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Cho Ja-Yun
Jung Hee-Kyung
Kim Hyung-Kee
Lim Kyoung-Hoon
Chun Jae-Min
Huh Seung
Park Jin-Young
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Abstract
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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 followup period.
Conclusion: Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.
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KEYWORD
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Arteriovenous fistula, Superior mesenteric artery, Mesenteric veins, Vascular system injuries
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