Pylephlebitis secondary to a gangrenous appendicitis a forgotten complication: a case report and review of the literature

Rito J. Medellin; Jesus A. Silva

doi:10.18203/2320-6012.ijrms20243377

Authors

Rito J. Medellin Department of General Surgery, Central Hospital “Dr. Ignacio Morones Prieto”, San Luis Potosi, Mexico
Jesus A. Silva Department of General Surgery, Central Hospital “Dr. Ignacio Morones Prieto”, San Luis Potosi, Mexico

DOI:

https://doi.org/10.18203/2320-6012.ijrms20243377

Keywords:

Portail vein, Appendicitis, Hepatic abscess, Case report, Pylephlebitis, Portal vein thrombosis, Cholangitis presentation

Abstract

Pylephlebitis is an uncommon condition which can complicate intrabdominal sepsis of any etiology. A 22-year-old male with 2 weeks of epigastric and right upper quadrant pain with associated fever, chills, nausea, vomiting, hyperbilirubinemia and leukocytosis in blood test documented. An acute cholangitis was the first diagnosis. Abdominal ultrasound described multiple abscesses and gallbladder wall thickening. CT scan revealed a case of acute appendicitis complicated with a thrombosis of the portal vein. Diagnostic laparoscopy was performed, observing 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. Pylephlebitis can present as a clinical cholangitis-like scenario with hyperbilirubinemia with liver abscess formation. 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. Surgical removal of the source of infection and adequate antibiotic treatment adjusted by culture should be initiated promptly. Anticoagulant treatment should be considered in the case of poor clinical outcome or thrombosis progression. Pylephlebitis should suspected 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.

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