The patient proceeded directly to trauma laparotomy from the trauma bay being haemodynamically unstable post-stabbing. Operative findings were right upper quadrant bleeding and an expanding retroperitoneal hematoma. The abdomen was packed and closed with a vacuum dressing and the patient proceeded to CT.

CT demonstrated multiple injuries:

• superior mesenteric artery injury with active bleeding into the retroperitoneum and left psoas muscle
• multifocal active bleeding points in the left psoas and quadratus lumborum muscles
• traumatic arteriovenous fistula between the superior mesenteric artery and left renal vein
• active arterial bleeding from the lower splenic pole
• possible pancreatic head laceration

Endovascular treatment of the superior mesenteric artery was considered but thought to be higher risk than open operative management, and the patient proceeded to successful open surgical repair of the SMA injury.