Ligation of inferior vena cava for septic thrombophlebitis

Abstract

A case is presented wherein an old retropelvic infection became active with the organism aerobacter cloacae and continued to cause a septic iliofemoral thrombophlebitis of the right side. This was temporarily controlled by streptomycin but the organism rapidly developed a resistance to the drug. The septic thrombophlebitis suddenly spread to the left iliofemoral system and the inferior vena cava was ligated in an attempt to control the septicemia. On the sixth postoperative day the patient developed a suppurative meningitis with the same organism and died two days later. Following ligation of the inferior vena cava there was moderate edema of both thighs, particularly the left and of the back up to the shoulder blades which reached its maximum degree on the third day and subsided to practically normal by the eighth day. Streptomycin when first administered was effective in inhibiting the growth of aerobacter cloacae but rapidly lost its value. In vitro tests showed: first day, 0.5 micrograms of streptomycin per cc. of agar inhibited growth; eleventh day, 3.0 micrograms per cc. agar inhibited growth; twenty-fifth day, 40.0 micrograms per cc. agar inhibited growth, and thirty-third day, 500.0 micrograms per cc. agar inhibited growth.