Case Reports
Pylephlebitis after appendicitis in a child

https://doi.org/10.1053/jpsu.2001.27052Get rights and content

Abstract

Septic phlebitis of the portal vein, or pylephlebitis, is a rare but potentially severe complication of abdominal sepsis. The authors present a case of pylephlebitis after perforated retrocecal appendicitis in a child and discuss the etiology, presentation, diagnosis, and treatment of this disorder in the modern era. J Pediatr Surg 36:1574-1576. Copyright © 2001 by W.B. Saunders Company.

Section snippets

Case report

A 7-year-old girl with previously diagnosed asthma had abdominal pain, vomiting, diarrhea, and fever to 40°C 2 weeks before admission. The pain, vomiting, and diarrhea improved after 4 days, but a recurrent high fever to 40°C with rigors persisted. Evaluation in the local health center and a brief stay in the hospital failed to establish the etiology. Eleven days after the beginning of the symptoms she was readmitted in the local hospital with a recurrent high fever, fluctuating epigastric

Discussion

There are few reports of portal and mesenteric vein thrombosis in pediatric patients with appendicitis.1, 2, 3 The process begins as a thrombophlebitis of a small vein draining the infected organ. The thrombus spreads to a larger collecting vessel, and pieces of infected thrombus break off and are swept into the liver. Hepatic abscesses may ensue, or the thrombosis may progress to involve the mesenteric veins, leading to bowel ischemia, infarction, and death. Before the advent of antibiotics,

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    2022, Annals of Medicine and Surgery
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    Nonspecific presentation makes its diagnosis difficult. The presentation may include spiking fever, right upper quadrant abdominal pain, anorexia, weight loss and malaise [6]. However, children may present with subtle findings [6].

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    In the pre-antibiotic era there were many reported cases of pylephlebitis with obliteration of the portal venous and splenic veins with extension to the distal mesenteric veins [7]. Modern literature contains only small cases series and case reports of MVT complicating acute appendicitis [6,8–11]. The overall purpose of this study was to assess the modern incidence of MVT in the setting of acute appendicitis, review patient management for identified cases, and define optimal management for this rare presentation.

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Address reprint requests to Kari Vanamo, MD, PhD, Department of Pediatric Surgery, Kuopio University Hospital, 70211 Kuopio, Finland.

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