medigraphic.com
ISSN 1561-2945 (Print)

2022, Number 2

<< Back Next >>

Revista Cubana de Cirugía 2022; 61 (2)

Pylephlebitis as a complication of acute appendicitis in a pregnant patient

Guanuchi QF, Moya RK, González RL

Language: Spanish
References: 24
Page: 1-16
PDF size: 539.99 Kb.


ABSTRACT

Introduction: Pylephlebitis, septic thrombosis of the portal system due to acute abdominal inflammatory conditions, it presents with variable clinical signs depending on the cause of origin and the affected portal branch. Diagnosis includes normal or mildly impaired liver function with leukocytosis, positive blood cultures, Doppler echocardiography, or computed tomography confirming the disease.
Objective: To describe pylephlebitis as an unusual complication in a pregnant patient with acute appendicitis, referring to its concept, pathophysiology, clinical presentation, diagnosis and therapeutic measures.
Clinical case report: This is the case of an 18-year-old female pregnant patient, who had severe abdominal pain, accompanied by vomiting, diarrhea and jaundiced stools. For such reasons, she was transferred to the Ambato General Teaching Hospital. Sepsis of abdominal origin was diagnosed due to acute perforated appendicitis, generalized peritonitis complicated with pylephlebitis. Surgical intervention was performed and the clinical condition was solved.
Conclusions: Pylephlebitis represents a great diagnostic difficulty, hence tools such as Doppler ultrasound and computed tomography are helpful in these cases. The mainstays of treatment include control of the abdominal septic focus and treating pylephlebitis.


REFERENCES

  1. Pérez S, Nofuentes C, García A, Luri P, Morales M, García S, et al. Pylephlebitis: a rare but possible complication of intra-abdominal infections. Rev Cir y Cir de la Academia Mexicana de Cirugía. 2015[acceso 21/12/2019];83(6):501-5. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/?term=appendicitis+with+pileflebitis 1.

  2. Charria JG, Martínez RN, Serna A. Pileflebitis. Rev Act Méd Col. 2016;41(2):148-50. Disponible en: http://www.scielo.org.co/pdf/amc/v41n2/v41n2a13.pdf2.

  3. Hernández Cortez J, De León Rendón J, Martínez Luna M, Guzmán Ortiz J, Palomeque López A, Cruz López N, et al. Apendicitis aguda: revisión de la literatura. Rev Cir Gen. 2019 [acceso 21/12/2019];41(1):33-8. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/cirgen/cg-2019/cg191f.pdf 3.

  4. Instituto Nacional de Estadística y Censos. La apendicitis aguda, primera causa de morbilidad en el Ecuador. INEC. 2018 [acceso 21/12/2019]. Disponible en: Disponible en: https://www.ecuadorencifras.gob.ec/la-apendicitis-aguda-primera-causa-de-morbilidad-en-el-ecuador/ 4.

  5. Restrepo Castro O, Granados Casallas N, Usta Stavoli C, Castillo Zamora M. Diagnosis of appendicitis in the third trimester of gestation: case report and review of the literature. Revista Colombiana de Obstetricia y Ginecología. 2018[acceso 21/12/2019];69:124-31. Disponible en: Disponible en: http://www.scielo.org.co/pdf/rcog/v69n2/2463-0225-rcog-69-02-00124.pdf 5.

  6. Koshy Zachariah S, Fenn M, Jacob K, Alias Arthungal S, Zachariah S. Management of acute abdomen in pregnancy: current perspectives. International Journal of Women's Health. 2019[acceso 23/12/2019];11:119-34. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371947/ 6.

  7. Hwan Lee S, Young Lee J, Young Choi Y, Gil Lee J. Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis. BMC Surgery. 2019[acceso 23/12/2019];4:1-12. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482586 7. /

  8. Mohamed El Ghali A, Kaabia O, Mefteh Z, Jgham M, Tej A, Sghayer A, et al. Acute appendicitis complicating pregnancy: a 33 case series, diagnosis and management, features, maternal and neonatal outcomes. Pan African Medical Journal. 2018[acceso 23/12/2019]. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294971/ 8.

  9. Bazeliuc I, Gugava V, Bour A. Acute appendicitis. The Moldovan Medical Journal. 2018[acceso 23/12/2019];61(2):28-37. Disponible en: Disponible en: https://zenodo.org/record/1299028#.YFyJOK8zY2w 9.

  10. Miralles O, Ariza D, Betancor É, Fontecha BJ. Pileflebitis o trombosis séptica portal. Rev Esp de Geriatría y Gerontología. 2019[acceso 23/12/2019];54(1):49-58. Disponible en: Disponible en: https://www.elsevier.es/es-revista-revista-espanola-geriatria-gerontologia-124-pdf-S0211139X18305900 10.

  11. Stine JG. Concise Commentary: The Clot Thickens-Why Pylephlebitis Is One of the Most Feared Complications of Intra-abdominal Sepsis. Digestive Diseases and Sciences. 2019[acceso 23/12/2019]2;64:1722-3. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/30604377/ 11.

  12. Londoño E, Hernández JD, Rey M, Cabrera F, Medellín A, Lopez P, et al12. . Pylephlebitis both a surgical and non-surgical pathology: A 2-case report and literature review. Journal of Liver Research, Disorders & Therapy. 2018[acceso 23/12/2019];4:1381-2471. Disponible en: Disponible en: https://medcraveonline.com/JLRDT/pylephlebitis-both-a-surgical-and-non-surgical-pathology-a-2-case-report-and-literature-review.html 12.

  13. Intagliata N, Caldwell S, Tripodi A. Diagnosis, Development, and Treatment of Portal Vein Thrombosis in Patients With and Without Cirrhosis. Reviews in basic and clinical gastroenterology and hepatology, The American Journal of Gastroenterology. 2019[acceso 26/12/2019];156(6):1582-99. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/30771355/ 13.

  14. Wu M, Schuster M, Tadros M. Update on Management of Portal VeinThrombosis and the Role of Novel Anticoagulants. Journal of Clinical and Translational Hepatology. 2019[acceso 26/12/2019];7:154-64. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609842/ 14.

  15. Correa S, Valiño J, Dufrechou C. Pileflebitis. Un desafío diagnóstico. Arch. Med Int. 2015[acceso 26/12/2019];37(3):144-6. Disponible en: Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-423X2015000300009&lang=es 15.

  16. Shu-Cheng K, Yi-Chun C, Chun-Chieh C. Portal Vein Thrombosis Resulted from Delay Diagnosis of Ruptured. Journal of Surgical Research. 2019[acceso 03/01/2020];1(3):1-3. Disponible en: Disponible en: http://www.scivisionpub.com/pdfs/portal-vein-thrombosis-resulted-from-delay-diagnosis-of-ruptured-appendicitis-1019.pdf 16.

  17. Hale G, Sakkal L, Galanis T. Pylephlebitis treated with apixaban. Hospital Practice. 2019[acceso 03/01/2020];47(4):192-5. Disponible en: Disponible en: https://www.tandfonline.com/doi/abs/10.1080/21548331.2019.1670476 17.

  18. Cheng Z, Wang F, Liu J. Transjugular intrahepatic portosystemic shunt assisted with trans-splenic access. Clinical and Molecular Hepatology. 2019[acceso 03/01/2020];25(4):417-9. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933119/18.

  19. Casuso-Sáenz E, Valiente-Millán M, Jaso-Tejera R, Campo-Ruíz A, Herreras Martínez R, Calvo-Mijares N, et al19. . Pileflebitis como causa de fiebre. Med Int Méx.. 2017[acceso 03/01/2020];33(6):818-21. Disponible en: Disponible en: http://www.scielo.org.mx/pdf/mim/v33n6/0186-4866-mim-33-06-818.pdf 19.

  20. Cotter T, Pillai A. Consult for Portal Vein Thrombosis. Clinical Liver Disease. 2019[acceso 06/01/2020];14(2):74-7. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6726384/ 20.

  21. Rohini S, Abilasha R. Awareness of factors related to acute appendicitis - A survey. Drug Invention Today. 2019[acceso 06/01/2020];11(5):1155-60. Disponible en: Disponible en: http://jprsolutions.info/files/final-file-5cdd8bf6175514.49670249.pdf 21.

  22. Serracant-Barrera A, Llaquet-Bayo H, Sánchez-Delgado, Jordi RMA, Dalmau-Obrador B, Bejarano-González N, et al22. . Pylephlebitis and liver abscesses secondary to acute advanced appendicitis. Rev Esp de Enfermedades Digestivas. 2015[acceso 06/01/2020];107(6):397-8. Disponible en: Disponible en: http://scielo.isciii.es/pdf/diges/v107n6/carta8.pdf 22.

  23. Mangal R, Stead T, Ganti L, Rosario J. Diagnosing Appendicitis in Pregnancy Via Ultrasonography. Cureus Journal of Medical Science. 2019[acceso 07/01/2020];11(9). Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820664/pdf/cureus-0011-00000005562.pdf 23.

  24. Zachariah SK, Fenn M, Zachariah SA. Management of acute abdomen in pregnancy: current perspectives. International Journal of Women’s Health. 2019[acceso 07/01/2020];11:119-34. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371947/ 24.




2020     |     www.medigraphic.com