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An unusual complication of acute appendicitis: isolated superior mesenteric venous pylephlebitis

Habib Bellamlih, Amine Bentahar, Khalil Chafi

  • 1Surgery department, Avicenna Military Hospital of Marrakech, Marrakech, Morocco.

BJR Case Reports
|November 6, 2023
PubMed

Insights

Pylephlebitis, a rare condition involving septic thrombophlebitis of the portal vein, can be diagnosed with imaging. Prompt treatment of appendicitis with abscess and superior mesenteric venous pylephlebitis led to full recovery and vein recanalization.

Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Infectious Diseases

Background:

  • Pylephlebitis is septic thrombophlebitis of the portal vein or its tributaries.
  • Superior mesenteric venous thrombophlebitis is an uncommon presentation of pylephlebitis.
  • It often originates from infections within the portal venous system's drainage, such as appendicitis or diverticulitis.

Observation:

  • A case of acute appendicitis complicated by an intra-abdominal abscess and superior mesenteric venous pylephlebitis was observed.
  • Preoperative diagnostic imaging played a crucial role in the early diagnosis of this acute phase pylephlebitis.
  • The patient underwent appendicectomy, abscess drainage, and received antibiotic and anticoagulant therapy.

Findings:

  • The patient achieved a full recovery following the comprehensive treatment approach.
  • Follow-up imaging at two months demonstrated complete recanalization of the superior mesenteric vein.
  • This indicates the successful resolution of the thrombophlebitis.

Implications:

  • Early diagnosis through preoperative imaging is vital for managing acute pylephlebitis.
  • A multi-modal treatment strategy including surgery, antibiotics, and anticoagulation can lead to favorable outcomes.
  • Complete venous recanalization is achievable, highlighting the potential for full recovery from superior mesenteric venous thrombophlebitis.

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