Case 25-2005

Kasper, Dennis L.; Sahani, Dushyant V.; Misdraji, Joseph

doi:10.1056/nejmcpc059020

Cited by 39 publications

(20 citation statements)

References 24 publications

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“…The major pathogenic microorganisms isolated in blood cultures are gram-negative enteric aerobes and anaerobes, and the bacteremia is frequently polymicrobial [10]. The initial empirical antibiotic treatment should include coverage for those pathogens, and should be adjusted according to antibiotic sensitivity [3,6,10].In the case reported, blood cultures were all negative, possibly due to early antibiotic treatment. No direct cultures were taken during the operation.…”

Section: Discussionmentioning

confidence: 88%

“…The current initial treatment approach is aggressive broad-spectrum antibiotic therapy and surgical removal or drainage of the precipitating focus of infection [3,6,10]. Anticoagulation therapy is still controversial and is reserved for patients with mesenteric vein thrombosis, hypercoagu-patient appeared acutely ill, mild discomfort in the right upper quadrant was noticed.…”

Section: Introductionmentioning

confidence: 98%

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Pylephlebitis due to perforated appendicitis in a teenager

et al. 2008

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Pylephlebitis, a septic thrombophlebitis of the portal vein, is a life-threatening complication of intraabdominal infections, commonly associated with acute appendicitis in children, and diverticulitis in adults. A 13-year-old boy was admitted for high fever and jaundice. On the fifth day of hospitalization, ultrasound Doppler flow and Computer Tomography scan studies showed thrombosis of the portal vein and acute appendicitis. The patient was treated with antibiotics, anticoagulation and laparotomy with appendectomy. No thrombophilic risk factors were diagnosed. Our aim is to improve physicians' awareness of this complication and emphasize the importance of early diagnosis and appropriate therapy in children in order to reduce serious complications and long-term sequels.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 98%

Pylephlebitis due to perforated appendicitis in a teenager

et al. 2008

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“…Further extension into the larger veins leads to septic thrombophlebitis of the portal vein and eventually of the mesenteric veins. [10] Presenting symptoms often include fever and abdominal pain while rigors, nausea and vomiting are less commonly reported. [1]…”

Section: Discussionmentioning

confidence: 99%

A rare case of pylephlebitis after colonic polypectomy

Nazir

Jehangir

Siddiqui

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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Pylephlebitis or infective suppurative thrombosis of the portal mesenteric venous system is an uncommon condition that can potentially be deadly if not recognized and treated early. Although most commonly associated with pancreatitis and diverticulitis, any intra-abdominal or pelvic infection occurring in the region drained by the portal venous system can cause this rare entity. We report a case of a 75-year-old woman who developed post polypectomy pylephlebitis following colonoscopy, a condition rarely reported in the literature.

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“…MRI can help to distinguish acute from chronic portal vein thrombosis [6]. Management of pylephlebitis is best achieved by treating the primary source using broad-spectrum intravenous antibiotics and surgical intervention (appendectomy or colectomy with abscess drainage) [1,2]. Early diagnosis and treatment is critical.…”

Section: Discussionmentioning

confidence: 99%

“…The common causes include diverticulitis, appendicitis or cholangitis [1]. Pylephlebitis has to be differentiated from the bland portal vein thrombus.…”

Section: Introductionmentioning

confidence: 99%

Diverticulitis complicated by pylephlebitis: a case report

2011

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IntroductionPylephlebitis is defined as septic thrombophlebitis of the portal venous system, usually secondary to infection or inflammation in the abdomen. In the current report, we present a case of pylephlebitis that complicated the course of a very common pathology, diverticulitis.Case presentationA 62-year-old Caucasian woman with a history of sigmoid diverticulitis presented to our facility with a three-week history of abdominal pain, fevers, chills, loss of appetite and fatigue. Her laboratory test results showed leukocytosis and elevated alkaline phosphatase. A computed tomography scan revealed portal vein thrombosis and a sigmoid diverticulitis with an abscess. Our patient was given pipercillin-tozabactam followed by sigmoid colectomy and loop transverse colostomy. A peritoneal fluid sample culture grew Escherichia coli. Our patient had an uneventful post-operative course and the leukocytosis resolved in the next four days. She improved clinically and was discharged home on ertapenem and enoxaparin. A follow-up computed tomography scan two weeks later showed a new pelvic abscess that was drained by a pigtail catheter but there was no change in the portal venous thrombus. A repeat computed tomography scan one month later revealed resolution of the pelvic abscess but persistence of portal vein thrombus, for which enoxaparin was continued.ConclusionsThis is a classic case of pylephlebitis that demonstrates the importance of recognizing that the portal vein thrombus is infected and treating the condition appropriately.

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Case 25-2005

Cited by 39 publications

References 24 publications

Pylephlebitis due to perforated appendicitis in a teenager

Pylephlebitis due to perforated appendicitis in a teenager

A rare case of pylephlebitis after colonic polypectomy

Diverticulitis complicated by pylephlebitis: a case report

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