AbstractDuring a 23‐year interval, 83 patients with wounds of the portal and/or superior mesenteric veins underwent emergency laparotomy. Six (7%) of the injuries were due to blunt trauma, while penetrating wounds accounted for the remaining 77 (93%). With one exception, associated organ injuries were routinely present and involved 120 other major vascular structures in 59 (71%) of the patients. Five patients with both portal and superior mesenteric vein injury and 3 others with isolated portal venous injury exsanguinated before repair could be accomplished.Lateral phleborrhaphy gave survival in 24 of 34 patients so treated. End‐to‐end reanastomosis of the portal vein was successful in only 1 of 3 patients on whom it was attempted, while the single portacaval shunt led to a metabolic death. Of the initial 17 patients having vein ligation as a desperation measure, there were 7 survivors. Subsequent immediate application of this technique whenever lateral repair was impossible or impractical was successful in 17 of 20 so managed.Death resulted from hemorrhagic shock (20), its attendant coagulopathy (7), or renal failure (2) in 29 patients. Two deaths were the result of failure to over‐transfuse appropriately when portal venous ligation or thrombosis with its attendant splanchnic sequestration led to significant peripheral hypovolemia. The overall mortality rate was 41%, with individual mortality rates of 46% and 27% for the portal and superior mesenteric veins, respectively. There was no survival if both veins had been injured.