“Collaterals a savior” in superior mesenteric artery injury post radical nephrectomy and retroperitoneal lymph node dissection

Superior Mesenteric Artery (SMA) during renal surgery is rarely reported but potentially devastating complication. It can rarely occur in patients with distorted vascular anatomy like in large left renal tumors with vascular infiltration and bulky lymphadenopathy, or in the setting of re-do surgery with extensive scarring. Failure to recognize and repair an SMA injury may result in ischemic bowel and consequently high mortality. Herein, we present a case scenario of injury to the SMA during radical nephrectomy missed intraoperatively and managed conservatively in the post-operative period in view of collateral circulation to the gut.