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Pylephlebitis associated with diverticulitis

M J Perez-Cruet1, E Grable, M S Drapkin

  • 1Department of Surgery, Newton-Wellesley Hospital, Mass.

Southern Medical Journal
|May 1, 1993
PubMed
Summary
This summary is machine-generated.

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Acute pylephlebitis, a rare but serious complication of abdominal sepsis, can be successfully treated with prompt antibiotic therapy. Early diagnosis and broad-spectrum antibiotics are crucial for resolving portal vein thrombosis and preventing severe complications.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Vascular Surgery

Background:

  • Pylephlebitis, characterized by acute suppurative thrombophlebitis of the portal venous system, is a rare but life-threatening complication of intra-abdominal infections.
  • It is frequently associated with conditions such as diverticulitis, appendicitis, and inflammatory bowel disease.
  • Portal vein thrombosis and septic hepatic emboli are common sequelae.

Observation:

  • This report details two cases of acute pylephlebitis secondary to right colonic diverticulitis.
  • Both patients presented with symptoms indicative of severe intra-abdominal sepsis and portal venous system involvement.
  • Escherichia coli was identified as a potential causative pathogen in pylephlebitis.

Findings:

  • Prompt initiation of broad-spectrum antibiotic therapy, including ampicillin as a first-line agent, was crucial for patient management.

Related Experiment Videos

  • Early suspicion and timely intervention led to the resolution of portal vein thrombosis in both cases.
  • Hepatic abscess formation was averted, and full recovery was achieved without the need for surgical intervention.

    • Implications:

    • Pylephlebitis, though rare, is a treatable condition with a high mortality rate if not managed aggressively.
    • Early diagnosis and aggressive antibiotic treatment are paramount for favorable outcomes, potentially obviating the need for surgery.
    • This case series underscores the importance of considering pylephlebitis in the differential diagnosis of intra-abdominal sepsis and highlights the efficacy of early antibiotic management.