PMC6202787_01
Basic anatomy of the portosystemic circulation. Red circle delineates the site of injury.
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One of which was from one of the supra-renal tributaries of the Inferior Vena Cava (IVC) at its lateral wall and the other coming from the SMV just inferior to the pancreas (Fig. 1).
White arrow points at the SMV after repair. Yellow arrow points at the duodenum. Blue arrow points at the transverse colon.
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Therefore, we cleared the bleeding vessel above and below the injury, identified the lesion, applied proximal and distal pressure, and a couple of stiches were taken in a figure-of-eight manner using PDS sutures (Fig. 2, Fig. 3).
White arrow points at the pocket of pellets found in the retroperitoneum next to the aorta. Yellow arrow points at the duodenojejunal junction. Blue arrow points at the jejunum.
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Exploration of major vessels using Mattox and Kocher maneuvers revealed a pocket of pellets next to the aorta, without other injuries (Fig. 4).