Traumatic arteriovenous fistula of the superior mesenteric vessels

A case of traumatic arteriovenous fistula of the superior mesenteric vessels is added to a collective review of 16 previous cases. Nausea, vomiting, cramping abdominal pain, diarrhea, abdominal thrill and bruit were usually present. Arteriography was diagnostic. Four patients operated upon immediately or within 11 hours after penetrating abdominal trauma had superior mesenteric arteriovenous injuries repaired; the remainder had a mesenteric vascular injury missed at initial laparotomy. The location of the fistula determined the method of repair. Spontaneous obliteration occurred in one patient. In two of the three deaths, portal hypertension was persent and a fistula was discovered at autopsy; the other occurred 3 months after massive bowel resection. Thorough exploration of hematomas and lacerations of the mesentery will minimize or eliminate subsequent formation of an arteriovenous fistula.