Mesenteric venous thrombosis as a complication of appendicitis in an adolescent

Abstract

Rationale: Mesenteric venous thrombosis is an uncommon but potentially fatal condition that can cause bowel ischemia. It results from a systemic hypercoagulable state or abdominal infection draining into the portal venous system. Several cases regarding portomesenteric venous thrombosis as a complication of appendicitis were reported in adults, but there are far fewer reports in pediatric patients. The mortality rate of the condition is high if untreated, especially in children, reaching up to 50%. Patient concerns: A healthy 15-year-old male with no significant past medical history presented with right lower quadrant pain, lethargy, and fever. The computed tomography scan showed a focal thrombosis at the superior mesenteric vein branch and an inflamed appendix. Diagnoses: Mesenteric venous thrombosis complicating acute appendicitis. Interventions: Intravenous antibiotics along with anticoagulants and laparoscopic appendectomy Outcomes: After 1 month, a follow-up ultrasonography revealed full resolution of the thrombosis. Lessons: Appendicitis is one of the most frequently encountered causes of pediatric surgical emergencies; therefore, physicians should be conscious of mesenteric venous thrombosis as a possible complication of acute appendicitis, irrespective of whether patients have thrombophilic conditions or not.

Complicated Pylephlebitis Secondary to Perforated Appendicitis in an Adolescent

“…Other known etiologies include umbilical vein catheterization, necrotizing enterocolitis, acute and chronic pancreatitis, liver abscess, and inflammatory bowel diseases. [ 3 ]…”

“…Yoon et al . [ 3 ] reported a delay in diagnosis of few days to 6 weeks, and the main reason was attributed to the nonspecific presentation. Clinical features in children usually include fever, abdominal pain, jaundice, and generalized weakness.…”

“…[ 1 ] Due to its rarity, the overall incidence is unknown in children; however, adult studies estimate 2.7 per 100,000 person-years. [ 2 3 ] The diagnosis relies on clinical features, imaging of the portal system and underlying abdominal pathology, and positive blood/tissue cultures. [ 1 2 3 4 ] Prompt treatment with antibiotics with anticoagulation and surgical management is essential for patient survival.…”

“…[ 2 3 ] The diagnosis relies on clinical features, imaging of the portal system and underlying abdominal pathology, and positive blood/tissue cultures. [ 1 2 3 4 ] Prompt treatment with antibiotics with anticoagulation and surgical management is essential for patient survival. [ 1 ]…”

Septic thrombophlebitis of the portal vein – a case report

“…Management includes broad-spectrum antibiotic therapy for a minimum of 4-6 weeks, narrowed according to blood culture results. While controversial, anticoagulation therapy seems to lower thrombosis recurrence and mortality rate, with a recommended duration of at least 3-6 months or longer if an underlying thrombophilic condition is identified (9). In the case reported, partial recanalization of the PV was demonstrated, nevertheless, clinical and imaging follow-up should be maintained to exclude the development of portal hypertension (10).…”