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Interval laparoscopic appendectomy for appendicitis complicated by pylephlebitis

Karyn B Stitzenberg1, Mark D Piehl, Paul E Monahan

  • 1Cecil G. Sheps Center for Health Services Research and Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.

JSLS : Journal of the Society of Laparoendoscopic Surgeons
|May 20, 2006
PubMed

Insights

This case study shows successful minimally invasive treatment for children with ruptured appendicitis complicated by portal mesenteric venous thrombosis and pylephlebitis. Early antibiotics and anticoagulation followed by interval appendectomy led to a full recovery.

Area of Science:

  • Pediatric Surgery
  • Vascular Surgery
  • Infectious Diseases

Background:

  • Ruptured appendicitis can lead to life-threatening portal mesenteric venous thrombosis and pylephlebitis in children.
  • Traditional treatment often involves urgent exploratory laparotomy, prolonged antibiotics, and extended anticoagulation.

Purpose of the Study:

  • To report a successful minimally invasive approach for managing pediatric pylephlebitis and mesenteric venous thrombosis secondary to ruptured appendicitis.
  • To highlight an alternative treatment strategy to traditional surgical interventions.

Main Methods:

  • A 5-year-old girl with ruptured appendicitis, pylephlebitis, and mesenteric venous thrombosis was treated with intravenous antibiotics and anticoagulation.
  • The patient subsequently underwent an interval laparoscopic appendectomy.

Main Results:

  • The patient received 3 months of antibiotic and anticoagulation therapy.
  • Following interval laparoscopic appendectomy, the patient experienced a complete recovery with no adverse sequelae at 3-year follow-up.
  • This represents the first reported case of successful minimally invasive management for this condition.

Conclusions:

  • Minimally invasive management, including antibiotics and anticoagulation followed by interval appendectomy, is a viable and effective treatment for pediatric ruptured appendicitis with pylephlebitis and mesenteric venous thrombosis.
  • This approach offers a less invasive alternative to urgent laparotomy.
  • Further application of this treatment strategy in similar pediatric cases is recommended.
Abstract

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