A CASE OF SUPPURATIVE PYLEPHLEBITIS DUE TO ACUTE APPENDICITIS

Abstract

A case of suppurative pylephlebitis of the portal vein following acute appendicitis is reported. A 52-year-old male with uncontrolled diabetes mellitus developed acute abdominal pain and high fever. Although physical findings and laboratory data were indicative of the pre DIC state accompanied by liver dysfunction secondary to panperitonitis, CT examination suggested obstruction of the portal vein and superior mesenteric vein. During surgery, the appendix showed acute inflammatory changes with localized peritoneal abscess, and the ileocolic, superior mesenteric and extra hepatic portal veins were confirmed completely obstructed with thrombi. Following appendectomy, peritoneal lavage and drainage, a polyethylene catheter was inserted into the ileocolic artery, through which antibiotics and urokinase were injected in addition to the systemic administration of antibiotics, y-globulin, heparin, antithrombin-HI, and gabexate mesilate. Angiography on the 38 postoperative day revealed cavernous transformation of the portal vein, with the main portal trunk being completely obstructed. Escherichia coli was isolated from culture of blood sample collected preoperatively and that of ascites or the thrombus obtained during surgery. Suppurative pylephlebitis of the portal vein is a rare disease, but it can be associated with intraperitoneal infections including acute appendicitis, if the patient has some underlying disease such as diabetes mellitus. This case indicates that surgical removal of infected focus followed by conservative treatment is able to save the patient's life.