Howley IW, et al. - Given that the portal vein (PV) and superior mesenteric vein (SMV) injuries are correlated with lethal outcomes, researchers sought to determine if modern trauma care has improved these outcomes. At their Level 1 trauma centre, they identified 24 patients presenting over 10-years with PV/SMV injuries; of these, 7 had PV and 15 had SMV injuries and 2 had both; all had operative exploration. Penetrating trauma was reported in 67% of patients. They reported the mean injury severity score of 32.4, and the mean new injury severity score of 44.5. Mortality was 63%. The analysis reveals that PV and SMV injuries remain lethal despite advances (REBOA, damage control surgery and resuscitation, liberal use of ED thoracotomy). Other structures were injured ubiquitously. The major cause of death was early exsanguination. All survivors had successful venorrhaphy; death was reported in those who required more complex repairs. Morbidity and mortality were reported in relation to compromised mesenteric venous flow.