[Pylephlebitis in the child: a challenging diagnosis].

Area of Science:

• Pediatric Gastroenterology
• Infectious Diseases
• Vascular Surgery

Background:

• Pylephlebitis, or septic thrombophlebitis of the portomesenteric veins, is a rare but serious complication of intra-abdominal infections.
• Diagnosis in children is often delayed due to non-specific symptoms and normal physical examinations.
• Appendicitis is a common underlying cause, particularly when clinically subacute or retrocecal.

Observation:

• Two pediatric cases of pylephlebitis secondary to undiagnosed appendicitis are presented.
• One patient was initially misdiagnosed with Salmonella infection, highlighting diagnostic challenges.
• Computed tomography (CT) scans were crucial for accurate diagnosis in both cases.

Findings:

• Both children recovered satisfactorily after appendectomy, long-term antibiotic therapy, and anticoagulation.
• CT imaging is the preferred diagnostic modality, identifying pylephlebitis and its intra-abdominal source.
• Doppler sonography is valuable for monitoring portal vein thrombosis progression.

Implications:

• Prompt diagnosis and management of pylephlebitis, especially in pediatric cases of appendicitis, are essential for preventing complications.
• While anticoagulation in children remains debated, early initiation is often recommended to improve portal vein flow.
• Raising awareness of pylephlebitis as a complication of appendicitis can reduce diagnostic delays and improve patient outcomes.