Fatal outcome of pylephlebitis treated with transhepatic percutaneous drainage
Department of Surgery, Rabta Hospital, Tunis, TunisiaEuropean Journal of Radiology Extra 04/2009; DOI: 10.1016/j.ejrex.2008.10.005
Pylephlebitis, also called suppurative endophlebitis of the portal vein, is a rare potentially life-threatening acute abdominal complication of an intra-abdominal inflammatory process. Only early recognition substantially reduces the catastrophic mortality. As its clinical picture is fairly nonspecific, radiological findings, while not pathognomonic, are of great use in early diagnosis and management of these patients. We report a rare case of pylephlebitis with no identified intraperitoneal septic process in a 75-year-old man. Diagnosis was suspected on imaging features and confirmed with percutaneous transhepatic needle puncture. Thereafter, a drainage catheter was placed into the intrahepatic portal system. After a transient clinical improvement during the three following days, the drainage stopped and the patient developed a septic shock requiring transfer to intensive care but he died approximately 24 h later.
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ABSTRACT: Suppurative pylephlebitis is a rare condition with a significant mortality rate, ranging from 50% to 80%. We report a case of suppurative pylephlebitis complicating acute pancreatitis treated by percutaneous drainage in a 40-year-old woman. The patient had an uneventful recovery.CardioVascular and Interventional Radiology 11/2007; 30(6):1242-4. DOI:10.1007/s00270-007-9102-x · 2.07 Impact Factor
Article: Hepatic-Portal Venous Gas in Adults[Show abstract] [Hide abstract]
ABSTRACT: The roentgenographic finding hepatic--portal venous gas (HPVG) has been reported extensively in the pediatric and radiology literature. The surgical implications and clinical significance have yet to be fully defined. This study reviews the 60 reported cases in the literature and adds four new cases. HPVG appears as a branching radiolucency extending to within 2 cm of the liver capsule. HPVG is associated with necrotic bowel (72%), ulcerative colitis (8%), intra abdominal abscess (6%), small bowel obstruction (3%), and gastric ulcer (3%). Mucosal damage, bowel distention and sepsis predispose to HPVG. The current mortality rate of 75% represents an improvement from previous experience. Analysis of survivors indicates that the finding of HPVG requires urgent surgical exploration except when it is observed in patients with stable ulcerative colitis.Annals of Surgery 04/1978; 187(3):281-7. DOI:10.1097/00000658-197803000-00012 · 8.33 Impact Factor
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ABSTRACT: A 57-year-old woman presented with fever, vomiting and arthralgia, with a history of rheumatoid arthritis. Laboratory tests showed leucocytes, anaemia and elevation of C-reactive-protein (CRP). Blood cultures were positive for Gram negative bacteria and Streptococcus viridans. Patient underwent abdominal Computed Tomography (CT) scan revealing sigmoid acute diverticulitis with peridiverticular abscesses and thrombophlebitis within the inferior mesenteric and portal veins. She started antibiotic and anticoagulant therapy. After 20 days, a second CT revealed a thrombosis involving the superior mesenteric vein also. After 22 days of therapy the patient was discharged with the resolution of the septic status. Two months after discharge the patient underwent left hemicolectomy for a histopathologically documented diverticulitis with an uneventful postoperative course. This is a description of a rare association of septic thrombosis within the portal, inferior mesenteric and superior mesenteric veins during acute sigmoid diverticulitis with abdominal abscesses. Our therapeutic strategy was a first line medical approach and delayed surgery.Digestive and Liver Disease 01/2008; 39(12):1088-90. DOI:10.1016/j.dld.2007.04.015 · 2.96 Impact Factor
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