scholarly journals A Rare Case of Pylephlebitis as a Complication of Cholecystocolonic Fistula

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Kouki Imaoka ◽  
Saburo Fukuda ◽  
Hirofumi Tazawa ◽  
Sotaro Fukuhara ◽  
Yuzo Hirata ◽  
...  
Keyword(s):  
Portal Vein ◽  
Vein Thrombosis ◽  
Anterior Branch ◽  
Life Threatening ◽  
Cholecystocolonic Fistula ◽  
Intra Abdominal Infection ◽  
Upper Abdominal ◽  
Abdominal Infections ◽  
High Index Of Suspicion ◽  
Enhanced Computed Tomography

Pylephlebitis is defined as a septic thrombophlebitis of the portal vein and its tributaries that is associated with multiple suppurative abdominal infections. We report a case of pylephlebitis associated with a cholecystocolonic fistula (CCF). A 41-year-old man presented with upper abdominal pain and anorexia for 1 month. Abdominal contrast-enhanced computed tomography (CT) revealed thrombosis in the left and anterior branch of the portal vein and thickening of the walls of the portal vein and periside portals. The gallbladder was collapsed and pneumobilia was seen in the biliary tract. Blood culture was positive for Streptococcus anginosus. A diagnosis of thrombophlebitis of the portal vein associated with CCF was made, and the patient was immediately managed with an intravenous broad-spectrum antibiotic and anticoagulation. After the portal vein thrombosis (PVT) propagation and inflammation had subsided, cholecystectomy and partial resection of the transverse colon were performed. Pylephlebitis is rare but is a life-threatening complication of intra-abdominal infection. A high index of suspicion is required, and a CT scan should be performed immediately for an early diagnosis and appropriate treatment.

scholarly journals Magnetic Resonance Thrombus Imaging to Differentiate Acute from Chronic Portal Vein Thrombosis

TH Open ◽  
2020 ◽  
Vol 04 (03) ◽  
pp. e224-e230
Author(s):  
Lisette F. van Dam ◽  
Frederikus A. Klok ◽  
Maarten E. Tushuizen ◽  
Walter Ageno ◽  
Sarwa Darwish Murad ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Test Performance ◽  
Expert Panel ◽  
Three Dimensional ◽  
Acute Thrombosis ◽  
Vein Thrombosis ◽  
Thrombus Imaging ◽  
Enhanced Computed Tomography

Abstract Introduction Timely diagnosis and treatment of portal vein thrombosis (PVT) is crucial to prevent morbidity and mortality. However, current imaging tests cannot always accurately differentiate acute from chronic (nonocclusive) PVT. Magnetic resonance noncontrast thrombus imaging (MR-NCTI) has been shown to accurately differentiate acute from chronic venous thrombosis at other locations and may also be of value in the diagnostic management of PVT. This study describes the first phase of the Rhea study (NTR 7061). Our aim was to select and optimize MR-NCTI sequences that would be accurate for differentiation of acute from chronic PVT. Study Design The literature was searched for different MRI sequences for portal vein and acute thrombosis imaging. The most promising sequences were tested in a healthy volunteer followed by one patient with acute PVT and two patients with chronic PVT, all diagnosed on (repetitive) contrast-enhanced computed tomography (CT) venography to optimize the MR-NCTI sequences. All images were evaluated by an expert panel. Results Several MR-NCTI sequences were identified and tested. Differentiation of acute from chronic PVT was achieved with 3D T1 TFE (three-dimensional T1 turbo field echo) and 3D T1 Dixon FFE (three-dimensional T1 fast field echo) sequences with best image quality. The expert panel was able to confirm the diagnosis of acute PVT on the combined two MR-NCTI sequences and to exclude acute PVT in the two patients with chronic PVT. Conclusion Using 3D T1 TFE and 3D T1 Dixon FFE sequences, we were able to distinguish acute from chronic PVT. This clinical relevant finding will be elucidated in clinical studies to establish their test performance.

scholarly journals Abdominal Sepsis: An Update

2018 ◽  
Vol 4 (4) ◽  
pp. 120-125 ◽  
Author(s):  
Mircea Gabriel Mureșan ◽  
Ioan Alexandru Balmoș ◽  
Iudita Badea ◽  
Ario Santini
Keyword(s):  
Antibiotic Therapy ◽  
Early Recognition ◽  
Abdominal Cavity ◽  
Abdominal Sepsis ◽  
Prognostic Scores ◽  
Significant Development ◽  
Surgical Measures ◽  
Life Threatening ◽  
Intra Abdominal Infection ◽  
Abdominal Infections

Abstract Despite the significant development and advancement in antibiotic therapy, life-threatening complication of infective diseases cause hundreds of thousands of deaths world. This paper updates some of the issues regarding the etiology and treatment of abdominal sepsis and summaries the latest guidelines as recommended by the Intra-abdominal Infection (IAI) Consensus (2017). Prognostic scores are currently used to assess the course of peritonitis. Irrespective of the initial cause, there are several measures universally accepted as contributing to an improved survival rate, with the early recognition of IAI being the critical matter in this respect. Immediate correction of fluid balance should be undertaken with the use of vasoactive agents being prescribed, if necessary, to augment and assist fluid resuscitation. The WISS study showed that mortality was significantly affected by sepsis irrespective of any medical and surgical measures. A significant issue is the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in the clinical setting, and the reported prevalence of ESBLs intra-abdominal infections has steadily increased in Asia. Europe, Latin America, Middle East, North America, and South Pacific. Abdominal cavity pathology is second only to sepsis occurring in a pulmonary site. Following IAI (2017) guidelines, antibiotic therapy should be initiated as soon as possible after a diagnosis has been verified.

scholarly journals Exploring the Outcomes of Portal Vein Thrombosis in the Clinical Setting of Cirrhosis, Malignancy, and Intra-abdominal Infections with and without Anticoagulation: A Retrospective 5-Year Study

2017 ◽  
Vol 27 (04) ◽  
pp. 208-212
Author(s):  
Joanne Joseph ◽  
Samuel Chew ◽  
Julie George ◽  
Tay Chin ◽  
Ashish Sule
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Complete Resolution ◽  
Vein Thrombosis ◽  
Risk Of Bleeding ◽  
Partial Resolution ◽  
Outcomes Measures ◽  
Increased Risk ◽  
Abdominal Infections

AbstractThe aim of this study was to understand the differences in clinical outcomes in portal vein thrombosis (PVT) patients with cirrhosis, malignancy, and abdominal infections, with or without anticoagulation. This study was approved by ethics committee. Data were collected from 2011 to 2016. Patients were classified into three groups: PVT with cirrhosis, malignancy, and infections. Primary outcomes measures collected were clot resolution, bleeding, recurrence, and death. Frequency, means, and percentages were calculated. In total, 30 patients were analyzed in this study. Mean age was 60.8 years (range of 30–91 years). There were 19 (63.3%) males and 11 (36.7%) females with ethnicity: 21 (70.0%) Chinese, 2 (6.7%) Malay, 2 (6.7%) Indian, and 5 (16.7%) other race. Fifteen patients received anticoagulation and 15 did not receive anticoagulation. Of the 15 patients who received anticoagulation, there was complete resolution of thrombus in 5 (33.3%), partial resolution in 1 (6.7%), and no resolution in 9 (60.0%). Of these 15 patients, there was bleeding in 3 (20.0%), there was no recurrence in 9 (60.0%), and 3 (20.0%) died during the period of follow-up. Of the 15 patients who did not receive anticoagulation, there was complete resolution of thrombus in 2 (13.3%), partial resolution in 0 (0.0%), and no resolution in 13 (86.7%). Of these 15 patients, there was bleeding in 0 (0%), there was recurrence in 2 (13.3%), and 6 (40.0%) died during the period of follow-up. Anticoagulation is effective in PVT. It reduces mortality with lower rate of recurrence. However, it is associated with increased risk of bleeding.

scholarly journals Portal Venous Thrombosis in a Special Operations Paratrooper: A Case Report

2021 ◽  
Author(s):  
Rachel E Bridwell ◽  
Sean Clerkin ◽  
Nathaniel R Walker ◽  
Brit Long ◽  
Sarah Goss
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Portal System ◽  
Thrombotic Occlusion ◽  
Special Operations ◽  
Vein Thrombosis ◽  
Portal Venous Thrombosis ◽  
Abdominal Infections

ABSTRACT Portal vein thrombosis is the thrombotic occlusion of the extrahepatic portal system, which can propagate towards the vena caval system. Although rare, it occurs primarily in those with cirrhosis, intra-abdominal infections, malignancy, or hypercoagulable disorders. This report describes the first reported case of a soldier within special operations without identifiable risk factors who was found to have a completely occlusive portal vein thrombosis after approximately 10 days of insidious abdominal pain. This case emphasizes the importance of considering this rare but dangerous pathology among this highly screened and capable special operations population.

Emergent treatment of variceal bleeding in two infants

2008 ◽  
Vol 49 (8) ◽  
pp. 951-954 ◽  
Author(s):  
A. Park ◽  
W. Cwikiel
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Biliary Atresia ◽  
Portal Vein Thrombosis ◽  
Variceal Bleeding ◽  
The Other ◽  
Bleeding Control ◽  
Vein Thrombosis ◽  
Life Threatening

Two infants with portal hypertension were treated on an emergency basis for life-threatening uncontrollable variceal bleeding. One 9-month-old girl had portal vein thrombosis, and the other 28-months-old girl had liver cirrhosis secondary to biliary atresia. Following percutaneous transhepatic embolization of the varices, successful bleeding control was achieved in both patients.

scholarly journals Portal Vein Thrombosis as a Complication of Laparoscopic Sleeve Gastrectomy: A Case Report

2020 ◽  
pp. 1-3
Author(s):  
Ramiz Iqbal ◽  
Ramiz Iqbal ◽  
Elvina Wiadji
Keyword(s):  
Risk Factors ◽  
Sleeve Gastrectomy ◽  
Portal Vein ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Portal Vein Thrombosis ◽  
Intraoperative Complications ◽  
Operative Management ◽  
Vein Thrombosis ◽  
Regional Center ◽  
Life Threatening

Portal vein thrombosis (PVT) is an uncommon and potentially life-threatening complication of bariatric surgery. Three cases of PVT were diagnosed at our regional center. All cases were post-laparoscopic sleeve gastrectomy without any intraoperative complications. All patients presented with vomiting and CT scans confirming PVT. No patients required operative management of venous mesenteric ischaemia and all were managed with anticoagulation. Two out of the three cases were found to have risk factors for venous thromboembolism. Surgeons should be aware of the vague symptomology of this rare entity and have a higher degree of suspicion in patients with risk factors of venous thrombosis.

scholarly journals A rare association of puerperal ovarian venous thrombosis with pseudomembranous colitis

2020 ◽  
Vol 9 (10) ◽  
pp. 4307
Author(s):  
Devika J. Kamat ◽  
Namrata P. Kavlekar
Keyword(s):  
Clostridium Difficile ◽  
Venous Thrombosis ◽  
Pseudomembranous Colitis ◽  
Puerperal Fever ◽  
Stool Culture ◽  
Vein Thrombosis ◽  
Persistent Symptoms ◽  
Puerperal Infection ◽  
Life Threatening ◽  
Enhanced Computed Tomography

Ovarian venous thrombosis is a rare but serious complication associated with early puerperium. The risk of this complication increases with associated puerperal infection or inflammatory condition. The present case report is of a 36-year-old lady who presented after emergency caesarean with puerperal fever and abdominal pain along with diarrhoea post antibiotic cover. Patient presented with moderate ascites and uterine subinvolution on examination. Contrast enhanced computed tomography (CECT) showed evidence of bowel wall edema due of colitis along with ovarian vein thrombosis. Patients had persistent symptoms despite receiving an empirical course of injectable cephalosporins. Stool culture confirmed growth of Clostridium difficile. Patient developed a rare infection after a course of antibiotic i.e. pseudomembranous colitis caused by Clostridium difficile. Patient then received a course of injectable vancomycin after which colitis subsided. This case increases our vigilance on management of puerperal fever which could get complicated with life-threatening events like deep vein thrombosis.

Imaging and radiological interventions of portal vein thrombosis

2005 ◽  
Vol 46 (4) ◽  
pp. 336-343 ◽  
Author(s):  
N. Hidajat ◽  
H. Stobbe ◽  
V. Griesshaber ◽  
R. Felix ◽  
R‐J. Schroder
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Portal Pressure ◽  
Alternative Methods ◽  
Vein Thrombosis ◽  
Contrast Enhanced ◽  
Local Methods ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients ◽  
Enhanced Computed Tomography

Portal vein thrombosis (PVT) is diagnosed by imaging methods. Once diagnosed by means of ultrasound, Doppler ultrasound can be performed to distinguish between a benign and malignant thrombus. If further information is required, magnetic resonance angiography or contrast‐enhanced computed tomography is the next step, and if these tests are unsatisfactory, digital subtraction angiography should be performed. Many papers have been published dealing with alternative methods of treating PVT, but the material is fairly heterogeneous. In symptomatic non‐cavernomatous PVT, recanalization using local methods is recommended by many authors. Implantation of transjugular intrahepatic portosystemic shunt is helpful in cirrhotic patients with non‐cavernomatous PVT in reducing portal pressure and in diminishing the risk of re‐thrombosis. In non‐cirrhotic patients with recent PVT, some authors recommend anticoagulation alone. In chronic thrombotic occlusion of the portal vein, local measures may be implemented if refractory symptoms of portal hypertension are evident.

Super-mesenteric-vein-expia-thrombosis, the clinical sequelae can be quite atrocious

2016 ◽  
Vol 28 (4) ◽  
pp. 445-449 ◽  
Author(s):  
Benjamin Howell Lole Harris ◽  
Jason Leo Walsh ◽  
Sarfraz A. Nazir
Keyword(s):  
Elevated Serum ◽  
Unknown Origin ◽  
Mesenteric Vein ◽  
Pyrexia Of Unknown Origin ◽  
Presenting Symptoms ◽  
Contrast Enhanced ◽  
Life Threatening ◽  
Intra Abdominal Infection ◽  
Enhanced Computed Tomography ◽  
Vague Abdominal Pain

Abstract Superior mesenteric vein (SMV) thrombosis is a rare, potentially life-threatening complication of intra-abdominal infection. Here we present a case of massive SMV thrombosis secondary to appendicitis in a 13-year-old boy. He presented with vague abdominal pain and associated symptoms, persistently elevated serum inflammatory markers and a pyrexia of unknown origin. Sonography proved inconclusive, and a definitive diagnosis was made by abdominal contrast-enhanced computed tomography. He was treated with antibiotics and anticoagulation before interval elective laparoscopic appendectomy. The non-specific nature of the presenting symptoms makes SMV thrombosis an important differential to consider when dealing with such patients.

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