A Case of Fulminant Portal Pyemia Complicating Hemicolectomy for Polyps: Literature Review and Case Report

SUMMARYA 70-year-old man presenting with long standing grade 3 Haemorrhoids, underwent open haemorrhoidectomy under spinal anaesthesia. The patient passed stools on subsequent day and there was no bleeding per rectum. On day 5, he complained of dull aching upper abdominal pain. On physical examination, the abdomen was soft and there was mild tenderness in the epigastric region. Subsequently, he developed high temperature with chills and rigors. His condition failed to improve and the abdominal pain increased in severity. There was no pain in the perianal region and per rectum examination was normal. Leucocyte count rose to 12×10 9 /L and there were toxic changes on peripheral smear. Blood culture grew Staphylococcus aureus. Liver enzymes were mildly elevated. Coagulation profile was deranged. Fibrin degradation products were positive. D-dimer was high. CT revealed acute thrombosis of left portal vein and microabscesses suggestive of portal pyaemia. BACKGROUND

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“…Surgical intervention includes percutaneous drainage, and if that is not possible, or fails, laparotomy and washout is necessary 5 8…”

Section: Discussionmentioning

confidence: 99%

“…Portal pyaemia itself has multiple complications which may include rupture into the liver causing liver abscess and empyema, as well as venous infarction of the bowel and portal hypertension (compression of the hepatic vein or inferior vena cava causing budd-chiari syndrome 5 9…”

Section: Discussionmentioning

confidence: 99%

Portal pyaemia secondary to open haemorrhoidectomy: need for prophylactic broad spectrum antibiotics

et al. 2013

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A Case of Fulminant Portal Pyemia Complicating Hemicolectomy for Polyps: Literature Review and Case Report

Abstract: Portal pyaemia is a condition which can lead to acute overwhelming sepsis and carries a high mortality. It should be considered a differential in abdominal sepsis when no overt abdominal source is found.

Cited by 1 publication

References 5 publications

Portal pyaemia secondary to open haemorrhoidectomy: need for prophylactic broad spectrum antibiotics

Portal pyaemia secondary to open haemorrhoidectomy: need for prophylactic broad spectrum antibiotics

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