Diagnosis and treatment of acute septic pylephlibitis

The Bottom Line: Key Points
• Pylephlebitis is the septic thrombosis of the portal
vein and septic shock may complicate it.
• Hypercoagulability and intra-abdominal sepsis are the
main predisposing factors for pylephlebitis.
• Doppler ultrasonography is an easy tool for diagnosing
vascular liver diseases.
• Anticoagulation and wide-spectrum antibiotics are indicated
in patients with acute pylephlebitis.

Reference: Altamirano A, et. al.  Acute pylephlebitis following gastrointestinal infection: an unrecognized cause of septic shock.  Southern Medical Journal (Sept. 2010) 103 (9):956-959.

Summary: Pylephlebitis is the septic thrombosis of the portal vein. Hypercoagulability and intra-abdominal sepsis are the main predisposing factors. A 25-year-old man presented to a primary health care center complaining of fever, epigastric pain, and jaundice. He was initially diagnosed with a gastrointestinal infection and alcoholic hepatitis and, due to his unstable clinical status, was referred to the emergency room. A diagnosis of acute pylephlebitis complicated with septic shock was made. Treatment with a wide-spectrum antibiotic and anticoagulation was initiated. Fifteen days later, recanalization of the portal vein was achieved and clinical status was improved. Pylephlebitis following gastrointestinal infection is a potential cause of septic shock.

See also: Jurado R, Mattix H.  The decreased serum urea nitrogen-creatinine ratio.  Arch Intern Med 1998 Dec 7-21;158(22):2509-11.

This entry was posted in Diagnosis, Grady, Therapy and tagged . Bookmark the permalink.