Once Universally Fatal: Pylephlebitis

Garrett, Andrew; Carnish, Erin; Das, Neha; Slome, Mary; Measley, Robert

doi:10.1016/j.amjmed.2014.01.020

Cited by 15 publications

(21 citation statements)

References 10 publications

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“…As management has improved with the use of antibiotics and surgery to control the infection, there has been a noted decline in cases of appendicitis leading to mortality as a result of pylephlebitis. 8,24 Many studies advocate the use of broad-spectrum antibiotics in the management of pylephlebitis, even in the absence of positive bacteremia. 8,15,20 Current recommendations state that antibiotic therapy should be used in pylephlebitis for up to 4 or 6 weeks in the presence of a liver abscess.…”

Section: Discussionmentioning

confidence: 99%

Pylephlebitis: a Review of 95 Cases

Choudhry

Baghdadi

Amr

et al. 2016

Journal of Gastrointestinal Surgery

143

214

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Pylephlebitis, or suppurative thrombophlebitis of the portal mesenteric venous system occurring in the setting of abdominal inflammatory processes, is a rare but deadly disease commonly associated with diverticulitis. We review our institutional experience in the management of patients with this condition. A retrospective review of medical records from 2002 to 2012 was performed. Patients with a portal mesenteric vein thrombosis (PMVT) within 30 days of an intra-abdominal inflammatory process were identified and evaluated. Ninety-five patients were included. The mean patient age at presentation was 57 years (range, 24–88). The most common associated processes were pancreatitis (31 %), followed by diverticulitis (19 %). Bacteremia was noted in 34 (44 %) patients. The most common organism cultured was Streptococcus viridans. Antibiotic and anticoagulation therapy was given in 86 (91 %) and 78 (82 %) patients, respectively. Overall, we report an 11 % mortality rate. Albeit rare, pylephlebitis most commonly was manifested in the setting of pancreatitis. Treatment should be individualized to culture results and extent of thrombosis. If diagnosed early and managed appropriately, a favorable outcome is possible.

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Section: Discussionmentioning

confidence: 99%

Pylephlebitis: a Review of 95 Cases

Choudhry

Baghdadi

Amr

et al. 2016

Journal of Gastrointestinal Surgery

143

214

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“…En la serie de Choudhry et al se identifica a la pancreatitis como la primera causa de tromboflebitis séptica portal, aunque este estudio fue realizado en un centro de referencia para pacientes con pancreatitis (9) . El cuadro 2 resume las condiciones reportadas y asociadas con la enfermedad (2,3,10,11) . El diagnóstico requiere un alto grado de sospecha, pues sus manifestaciones clínicas son inespecíficas, siendo las más comunes fiebre y dolor abdominal.…”

Section: Discussionunclassified

Trombosis séptica portal secundaria a diverticulitis

Guerra-Zarama¹,

García-Rincón

González-Pérez³

et al. 2021

CES Med

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La trombosis séptica de la vena porta es una complicación infrecuente de la diverticulitis, la apendicitis y de otras infecciones intraabdominales. Se asocia a elevadas tasas de complicaciones, como isquemia mesentérica, absceso hepático, hipertensión portal o muerte. Se presenta el caso de un paciente de 67 años quien consultó por fiebre, dolor abdominal e ictericia, y en quien se documentó bacteriemia por Escherichia coli y Streptococcus dysgalactiae. En las imágenes se identificó trombosis de la porta hepática secundaria a enfermedad diverticular aguda, lo que configura un diagnóstico de pileflebitis séptica. El paciente recibió terapia antibiótica dirigida, sin anticoagulación, obteniéndoseadecuada respuesta clínica. Se realiza una discusión sobre el diagnóstico, etiología y tratamiento de la trombosis séptica portal.

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“…Recommendations for the duration of antibiotic therapy vary. Nevertheless, it should be continued for a minimum of 4 weeks in most cases to avoid complications such as hepatic abscesses [ 1 , 15 , 18 ]. In our case, antibiotic therapy was administered for 6 weeks and anticoagulation for 12 months.…”

Section: Discussionmentioning

confidence: 99%

Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein

Bockmeyer

Taha‐Mehlitz

Heeren

et al. 2020

Case Reports in Surgery

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Thrombophlebitis of the portal vein (pylephlebitis) is a rare but serious condition with a high mortality rate of 11-50%. A 56-year-old male patient presented with a two-day history of postprandial, colic-like epigastric pain, nausea, fever, chills, and diarrhea. Clinical workup showed peritonism, leukocytosis, and elevated C-reactive protein (CRP). A computed tomography (CT) scan revealed a long-segment, partial thrombosis of the superior mesenteric vein as well as gas in the portal venous system. Additionally, extensive jejunal diverticulosis was present. Pylephlebitis mostly results from intestinal infections, e.g., appendicitis or diverticulitis. We assumed that the patient had suffered from a self-limiting episode of jejunal diverticulitis leading to septic thrombosis. Initially, antibiotic therapy and anticoagulation with heparin were administered. The patient deteriorated, and due to increasing abdominal defense, fever, and hypotension, a diagnostic laparoscopy was performed. Bowel ischemia could be ruled out, and after changing antibiotic therapy, the patient’s condition improved. He was discharged without any further complications and without complaints on day 13. An underlying coagulopathy like myeloproliferative neoplasm or antiphospholipid syndrome could be ruled out.

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Once Universally Fatal: Pylephlebitis

Cited by 15 publications

References 10 publications

Pylephlebitis: a Review of 95 Cases

Pylephlebitis: a Review of 95 Cases

Trombosis séptica portal secundaria a diverticulitis

Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein

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