Ramírez AEM, Núñez GEA, Choza CR, Santín RJ

Language: Spanish
References: 12
Page: 287-290
PDF size: 279.86 Kb.

ABSTRACT

Background: Pylephlebitis is a disease characterized by septic thrombophlebitis of the portal venous system, secondary to abdominal infection. The most common cause is diverticulitis. It has a high mortality and treatment should begin at an early stage to avoid complications. Case report: 55-year-old male, who began with abdominal pain located in the left iliac fossa. The physical exam revealed peritoneal irritation. With a suspected diagnosis of acute diverticulitis, an abdominal tomography was performed confirming the diagnosis. The patient was hospitalized receiving intravenous antibiotic treatment. Over the next 72 hours temperature of 39 oC and bacteremia developed. Laboratory results showed leukocytosis (15,300), 2% band, C-reactive protein 27.9 and procalcitonin 2.44. A new abdominal computed tomography (CT) scan was performed, which revealed a filling defect in the portal vein, compatible with thrombosis and hepatic abscesses. The diagnosis of pylephlebitis was made. Antibiotic treatment was adjusted and treatment with enoxaparin 60 mg every 12 hours was begun. The clinical outcome was favorable. A central catheter was placed for administration of parenteral drugs and he was discharged on the fifth day of hospitalization without complications. Conclusion: Pylephlebitis is a septic thrombophlebitis of the portal vein secondary to an abdominal septic process. It should be suspected in patients with persistent bacteremia despite appropriate antibiotic therapy. Initial management includes broad-spectrum antibiotics and formal anticoagulation.

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