INTRODUCTION Superior mesenteric artery (SMA) injury is a life-threatening condition that requires prompt identification and surgical intervention. The majority of SMA injuries occur secondary to penetrating trauma, with blunt trauma representing a rare etiology. CASE PRESENTATION We report the case of a 20-year-old Asian male presenting to the emergency department (ED) after he sustained blunt trauma to the abdomen during a motor vehicle accident, causing a mesenteric defect and SMA branch rupture. On arrival to the ED, the patient was hemodynamically stable. A focused assessment with sonography for trauma (FAST) demonstrated hemoperitoneum, and computed tomography angiography (CTA) revealed active contrast extravasation from a branch of the distal jejunal branch of the superior mesenteric artery with an associated mesenteric defect. Shortly after imaging, the patient developed hemodynamic instability, requiring transfusion of blood products and an urgent exploratory laparotomy with ligation of the injured SMA branch and repair of the mesenteric defect. He was subsequently admitted to the intensive care unit (ICU) for postoperative management. CLINICAL DISCUSSION This case highlights the diagnostic challenge of blunt SMA branch injuries, which may initially present with hemodynamic stability, but rapidly progress to life-threatening hemorrhage. A high index of suspicion should be maintained and patients should receive early imaging, close monitoring, and timely operative intervention are critical to prevent morbidity and mortality. CONCLUSIONS Blunt trauma associated SMA branch rupture is an uncommon but potentially fatal injury. Clinicians should maintain a high index of suspicion for mesenteric vascular injury in patients with high-energy blunt abdominal trauma, even when initial hemodynamic parameters appear reassuring.
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