Fullen et al developed a classification scheme for injuries to the superior mesenteric artery. Injury involving different portions (or zones) of the artery result in ischemic injury to different segments of the small bowel and/or colon.
Segment of the Superior Mesenteric Artery
Zone
Grade of Ischemic Injury
trunk proximal to the inferior pancreato-duodenal artery (first major branch)
I
1 (maximal)
trunk between the inferior pancreato-duodenal and middle colic arteries
II
2 (moderate)
trunk distal to middle colic artery
III
3 (minimal)
segmental branches (jejunal, ileal, colic)
IV
4 (none)
Zone
Bowel Segment Involved
I
jejunum, ileum and right colon
II
major segment of small bowel and/or right colon
III
1 or more minor segments of the small bowel or right colon
IV
none
where:
• An injury with a lower grade number is more serious than one with a larger number. In the Organ Injury Scale the opposite is true.
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