Abstract

CARRILLO ESPER, Raúl et al. Pylephlebitis secondary to appendicitis managed with thrombectomy, thrombolysis and anticoagulation. Cir. gen [online]. 2014, vol.36, n.2, pp.103-106. ISSN 1405-0099.

Introduction: Septic thrombosis of the portal vein or pylephlebitis is secondary to intraabdominal infectious processes, especially appendicitis and diverticulitis. Although its incidence has decreased to 0.05% from the advances in surgical techniques and the rational use of antibiotics, mortality remains high especially its complications, which include venous intestinal ischemia and sepsis.

Case Report: 36-year-old man who underwent laparoscopic appendectomy, fi ve days after the procedure the patient presented a clinical pictured characterized by fever, diffuse abdominal pain, abdominal distension, ileum and shock. Exploratory laparotomy was conduced, fi nding diffuse intestinal ischemia. The angiography showed thrombosis of the portal and superior mesenteric veins. The patient underwent alteplasebased thrombolysis as well as thrombectomy, after both procedures we continued the treatment with a continuous infusion of heparin and alteplase through a portal cathether. The complete recanalization as well as the reversion of the intestinal ischemia was achieved.

Conclusion: The early diagnosis of the septic pylephlebitis is critical to reverse the secondary intestinal ischemia and to promote the intestinal viability. Procedures as thrombectomy and thrombolysis as well as continuous infusion of heparin and a thrombolytic through the portal vein should be considered as part of the management of this entity.

Keywords : Pylephlebitis; Thrombolysis; Thrombectomy; Portal vein.