Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report

Pahari, Soumya; Shrestha, Manju; Basukala, Sunil; Kafle, Pooja; Rai, Kalpana; Khand, Yugant; Thapa, Ojas; Thapa, Anup

doi:10.1016/j.amsu.2022.104744

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…8 Pylephlebitis cannot be diagnosed immediately in most patients because of nonspecific symptoms. 9 Moreover, there is currently no diagnostic criteria for pylephlebitis. 10 Therefore, because of the vague symptoms at presentation, a high level of suspicion must be maintained to avoid fatal complications, and an early radiographic examination is necessary.…”

Section: Discussionmentioning

confidence: 99%

Pylephlebitis combined with septic shock secondary to acute nonperforated appendicitis: a case report

Wu,

Su,

2024

J Int Med Res

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Pylephlebitis, which is a type of septic thrombophlebitis of the portal vein, is a rare and life-threatening complication that commonly occurs following appendicitis. However, nonspecific abdominal complaints and fever can impede the diagnosis of pylephlebitis. Timely use of appropriate antibiotics and anticoagulants is paramount for treating this condition. We present a case of pylephlebitis and septic shock caused by acute nonperforated appendicitis. A 32-year-old man presented with migratory right lower abdominal pain. Blood cultures showed the presence of Escherichia coli. Blood test results showed increased bilirubin concentrations and coagulation factor abnormalities. A computed tomographic abdominal scan showed that the portal vein had a widened intrinsic diameter. After intensive care treatment with antibiotics, antishock therapy, anticoagulants, and other supportive treatments, the infection was monitored, the abdominal pain disappeared, and the jaundice subsided. Laparoscopic appendectomy was performed. Histopathology showed acute suppurative appendicitis, and no abnormalities were observed during the follow-up period after discharge. A multidisciplinary approach is mandatory for the decision-making process in the presence of pylephlebitis caused by appendicitis to obtain a correct diagnosis and prompt treatment. Similarly, the timing of appendectomy is important for minimizing intra- and postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Pylephlebitis combined with septic shock secondary to acute nonperforated appendicitis: a case report

Wu,

Su,

2024

J Int Med Res

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Pylephlebitis Secondary to a Gangrenous Appendicitis a Forgotten Complication. Case Report and a Review of the Literature

Silva Aguilar

2024

Revista Científica y Académica

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Introduction: Pylephlebitis is an uncommon condition with a significant mortality which can complicate intrabdominal sepsis of any etiology. (1) Case presentation: A 22-year-old male with 2 weeks of epigastric and right upper quadrant pain with associated fever and chills, nausea and vomiting, hyperbilirubinemia and leukocytosis in blood test was documented. An acute cholangitis was the first diagnosis. Abdominal ultrasound described multiple abscesses and gallbladder wall thickening, and inflammatory changes around the gallbladder. CT scan was performed and revealed a case of acute appendicitis complicated with a thrombosis of the portal vein. Diagnostic laparoscopy was performed, here we observed an inflammatory process in the right lower quadrant, cholecystectomy with cholangiography was done with no complications, and then appendicectomy was performed. Broad-spectrum antibiotic and anticoagulation treatment led to full recovery. Follow-up after 12 months showed a full recovery and no signs of thrombosis in the serial CT scans for follow-up. Discussion: Pylephlebitis can present as a clinical cholangitis-like scenario with hyperbilirubinemia with liver abscess formation. (2) CT scan seems to be the most sensitive diagnostic test because it can identify the underlying infection foci, it also can show the extension of the thrombosis and other complications like liver abscesses (3). Surgical removal of the source of infection and adequate antibiotic treatment adjusted by culture should be initiated promptly (4). Anticoagulant treatment should be considered in the case of poor clinical outcome or thrombosis progression (5). Conclusion: Pylephlebitis should be considered in the case of poor clinical outcome of intrabdominal infections, a properly diagnosis with imaging tests and multimodal management can reduce the morbidity and mortality, and also short- and long-term complications of this pathology (6).

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Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report

Cited by 2 publications

References 19 publications

Pylephlebitis combined with septic shock secondary to acute nonperforated appendicitis: a case report

Pylephlebitis combined with septic shock secondary to acute nonperforated appendicitis: a case report

Pylephlebitis Secondary to a Gangrenous Appendicitis a Forgotten Complication. Case Report and a Review of the Literature

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