Massive bleeding from a ruptured superior mesenteric artery aneurysm duodenum.

A traumatic false aneurysm of the superior mesenteric artery resulting from a gunshot wound five years previously, caused massive hemorrhage into the second portion of the duodenum. Dissection, resection, and end-to-end anastomosis was successful in controlling bleeding into the gastrointestinal tract, but immediate postoperative angiography showed a reappearance of the aneurysm, and three months later, it bled into the retroperitoneum. The patient underwent further resection and two subsequent reconstructions of the superior mesenteric artery, the first with a Dacron graft, which clotted, and the second with autologous saphenous vein, which was successful. Three years later, the patient is well. The case shows that adequate reconstruction of an arterial injury is best performed immediately after it is diagnosed.