This paper is only available as a PDF. To read, Please Download here.
Background
Pylephlebitis may complicate any intra-abdominal infection and carries a high mortality
rate. Acute cases are usually anticoagulated to prevent thrombus extension and enteric
ischemia; however, the role of anticoagulation has not been clearly defined.
Methods
Over a 3-year period, Pylephlebitis was diagnosed in 44 patients with portal vein
thrombosis on computed tomography scan with fever, leukocytosis, and/or positive blood
cultures. The charts were reviewed for etiology, extent of venous thrombosis, and
method and results of treatment.
Results
Eighteen patients were hypercoagulable, due to clotting factor deficiencies (6), malignancy
(8), or AIDS (4). Fifteen patients had mesenteric vein involvement. Thirty-two patients
were not anticoagulated, and 5 died (3 with hypercoagulable states and 2 with normal
clotting function). Twelve patients were anticoagulated, and none developed subsequent
bowel infarction or died.
Conclusion
Patients with pylephlebitis and a hypercoagulable state due to neoplasms or clotting
factor deficiencies should be anticoagulated. Patients with normal clotting function
and mesenteric vein involvement may also benefit. We believe anticoagulation in patients
with thrombus isolated to the portal vein and normal clotting function may be unnecessary.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diseases of the hepatic blood vessels.in: Bockus HL Gastroenterology. 4th ed. WB Saunders, Philadelphia1985: 3259-3277
- Suppurative pylephlebitis and pylethrombosis: the role of anticoagulation.Am Surg. 1995; 61: 1041-1044
- Suppurative pylephlebitis.South Med J. 1991; 84: 1396-1398
- NEJM. 1977; 296: 1051-1057
- Pylephlebitis secondary to unsuspected appendiceal rupture.AJDC. 1989; 143: 1099-1100
- Pylephlebitis associated with diverticulitis.South Med J. 1993; 86: 578-580
- Pylephlebitis and liver abscesses due to appendicitis.J Int Coll Surg. 1948; 115: 464-468
- Pylethrombosis: serendipitous radiologic diagnosis.Arch Surg. 1987; 122: 1116-1119
- Percutaneous diagnosis and drainage of pylephlebitis: a case report.Surgery. 1987; 101: 244-249
- Sonographic features of portal vein thrombosis.AJR. 1985; 144: 749-752
- Portal thrombosis: dynamic CT features and course.Radiology. 1985; 154: 737-741
- Factors influencing mortality in the treatment of pyogenic hepatic abscess.Surg Gynecol Obstet. 1975; 140: 228-234
- Diagnostic and therapeutic approaches to pyogenic abscess of the liver.Surg Gynecol Obstet. 1989; 168: 332-336
- CT of hepatic and fungal abscesses in leukemic children.Pediatr Infect Dis J. 1982; 1: 317-321
- Alterations of hemostasis in malignancy: etiology, pathophysiology, diagnosis and management.Semin Thromb Hemostas. 1978; 5: 1-26
- Hepatic abscess: changes in etiology, diagnosis and management.Ann Surg. 1990; 212: 655-662
- Protean manifestations of pylethrombosis.Ann Surg. 1985; 202: 191-201
- Syndromes of hypercoagulability and thrombosis: a review.Semin Thromb Hemostas. 1994; 20: 109-132
- Etiology of portal vein thrombosis in adults, A prospective evaluation of primary myeloproliferative disorders.Gastroenterol. 1988; 94: 1C63-1069
- Antithrombin III deficiency appearing as mesenteric venous thrombosis.Am J Gastroenterol. 1982; 76: 534-537
- Mesenteric vascular occlusion, Study of 99 cases of occlusion of veins.Mayo Clin Proc. 1949; 24: 628-636
- Spontaneous thrombosis of the mesenteric veins.Ann Surg. 1971; 173: 561-568
- Warfarin: from bedside to bench.NEJM. 1984; 311: 645-652
Article info
Footnotes
**Presented at the 48th Annual Meeting of the Southwestern Surgical Congress, Scottsdale, Arizona, April 28–May 1, 1996.
Identification
Copyright
© 1996 Excerpta Medica, Inc. All rights reserved. Published by Elsevier Inc.
