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Órgano Oficial de la Sociedad Mexicana de Angiología y Cirugía Vascular

2014, Number 4

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Rev Mex Angiol 2014; 42 (4)

El diagnóstico de pileflebitis por imagen seccional

Motta-Ramírez GA, González-Burgos O, Martínez-Utrera MJ, Luján-Cortés EI, García-Ruiz A, Ordóñez-Gutiérrez M

Language: Spanish
References: 49
Page: 150-162
PDF size: 341.44 Kb.


ABSTRACT

Introduction. Pylephlebitis or septic thrombophlebitis of the portal vein is a serious condition with significant morbidity and mortality. It is a rare but serious condition complication of intra-abdominal infection that occurs in the region drained by the portal venous system. The diagnosis of pylephlebitis requires the demonstration of a portal vein thrombosis usually accompanied by bacteremia in a febrile patient. Diagnosis is often difficult since no specific clinical signs, symptoms and laboratory parameters are involved. This may lead to a delay in treatment. Pylephlebitis is a condition with significant morbidity and mortality. The most common predisposing infections leading to pylephlebitis were appendicitis and diverticulitis.
Material and methods. Retrospective review of 9 years and 8 months with clinic-tomographic-pathologic correlation including 17 patients with pylephlebitis.
Results. A precipitating focus of infection (most commonly appendicitis) was identified in 6 (35%) of the cases. Pylephlebitis is a likely cause of hepatic abscess (47%); multiple (18%). More abscesses occur in the right than in the left lobe. Thrombosis was extended to branches of the portal vein in 16 (94%) and to the superior mesenteric vein, splenic vein, and intrahepatic in 8 (47%); in 13 (76%) a nonneoplastic hepatic vascular perfusion disorder was identified and in 2 (12%) vascular intraluminal gas was identified.
Conclusions. Pylephlebitis which may be difficult to diagnose even with imaging techniques such as CT scan. It should be considered in patients with sepsis due to gut-associated organisms without a clear source of infection. pylephlebitis remains an entity with high morbidity and mortality, but modern imaging modalities have facilitated an earlier diagnosis and have improved the prognosis. While diverticulitis is thought to be the leading cause of this disease, in our study appendicitis and cholecystitis occurs frequently, and various other suppurative intra-abdominal infections.


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