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Portal venous thrombophlebitis in a case of perforated appendicitis: lessons from a case

Renukadas Sakalkale1, Paul Reeve

  • 1Department of Paediatric Surgery, Waikato Hospital, Hamilton.

The New Zealand Medical Journal
|May 24, 2006
PubMed

Insights

Portal and mesenteric pyelephlebitis, a severe condition, can arise from appendicitis. Prompt treatment including surgery, antibiotics, and anticoagulation led to full recovery in a patient with superior mesenteric venous pyelephlebitis.

Area of Science:

  • Gastroenterology and Hepatology
  • Vascular Surgery
  • Infectious Diseases

Background:

  • Portal and mesenteric pyelephlebitis is a rare but serious condition.
  • It often stems from infections within the portal venous system's drainage area.
  • High morbidity is associated with this condition.

Observation:

  • A case of perforated acute appendicitis complicated by superior mesenteric venous pyelephlebitis and thrombocytopaenia is presented.
  • The patient underwent appendicectomy, broad-spectrum antibiotics, anticoagulation, and platelet transfusion.
  • Follow-up imaging confirmed complete resolution of the thrombosis.

Findings:

  • Successful management of complicated appendicitis with pyelephlebitis is demonstrated.
  • A multimodal treatment approach involving surgery, antibiotics, anticoagulation, and supportive care can lead to full recovery.
  • Conservative and surgical management options for mesenteric and portal venous thrombosis are discussed in the literature review.

Implications:

  • This case highlights the importance of recognizing and promptly treating pyelephlebitis secondary to intra-abdominal infections.
  • Aggressive management can prevent severe complications and improve patient outcomes.
  • Further research into optimal treatment strategies for mesenteric and portal venous thrombosis is warranted.

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