1
|
Hapshy V, Imburgio S, Sanekommu H, Nightingale B, Taj S, Hossain MA, Patel S. Pylephlebitis-induced acute liver failure: A case report and review of literature. World J Hepatol 2024; 16:103-108. [PMID: 38313245 PMCID: PMC10835482 DOI: 10.4254/wjh.v16.i1.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/24/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Pylephlebitis is an extremely rare form of septic thrombophlebitis involving the portal vein, carrying high rates of morbidity and mortality. CASE SUMMARY We present a case of a 42-year-old male with no past medical history who presented with acute onset of abdominal pain and altered mental status with laboratory tests demonstrating new-onset acute liver failure. Pylephlebitis was determined to be the underlying etiology due to subsequent workup revealing polymicrobial gram-negative anaerobic bacteremia and complete thrombosis of the main and left portal veins. To our knowledge, this is the first documented case of acute liver failure as a potential life-threatening complication of pylephlebitis. CONCLUSION Our case highlights the importance of considering pylephlebitis in the broad differential for abdominal pain, especially if there are co-existing risk factors for hypercoagulability. We also demonstrate that fulminant hepatic failure in these patients can potentially be reversible with the immediate initiation of antibiotics and anticoagulation.
Collapse
Affiliation(s)
- Vera Hapshy
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States.
| | - Steven Imburgio
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| | - Harshavardhan Sanekommu
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| | - Brandon Nightingale
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| | - Sobaan Taj
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| | - Mohammad A Hossain
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| | - Swapnil Patel
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| |
Collapse
|
2
|
Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis. Diagnostics (Basel) 2023; 13:diagnostics13030429. [PMID: 36766534 PMCID: PMC9914785 DOI: 10.3390/diagnostics13030429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/20/2022] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Pylephlebitis, defined as infective thrombophlebitis of the portal vein, is a rare condition with an incidence of 0.37-2.7 cases per 100,000 person-years, which can virtually complicate any intra-abdominal or pelvic infections that develop within areas drained by the portal venous circulation. The current systematic review aimed to investigate the etiology behind pylephlebitis in terms of pathogens involved and causative infective processes, and to report the most common symptoms at clinical presentation. We included 220 individuals derived from published cases between 1971 and 2022. Of these, 155 (70.5%) were male with a median age of 50 years. There were 27 (12.3%) patients under 18 years of age, 6 (2.7%) individuals younger than one year, and the youngest reported case was only 20 days old. The most frequently reported symptoms on admission were fever (75.5%) and abdominal pain (66.4%), with diverticulitis (26.5%) and acute appendicitis (22%) being the two most common causes. Pylephlebitis was caused by a single pathogen in 94 (42.8%) cases and polymicrobial in 60 (27.2%) cases. However, the responsible pathogen was not identified or not reported in 30% of the included patients. The most frequently isolated bacteria were Escherichia coli (25%), Bacteroides spp. (17%), and Streptococcus spp. (15%). The treatment of pylephlebitis consists initially of broad-spectrum antibiotics that should be tailored upon bacterial identification and continued for at least four to six weeks after symptom presentation. There is no recommendation for prescribing anticoagulants to all patients with pylephlebitis. However, they should be administered in patients with thrombosis progression on repeat imaging or persistent fever despite proper antibiotic therapy to increase the rates of thrombus resolution or decrease the overall mortality, which is approximately 14%.
Collapse
|
3
|
Suppurative Pylephlebitis With Portal Vein Abscess Mimicking Portal Vein Thrombosis: A Report of Two Cases. J Clin Exp Hepatol 2022; 12:208-211. [PMID: 35068801 PMCID: PMC8766560 DOI: 10.1016/j.jceh.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 01/03/2023] Open
Abstract
Suppurative pylephlebitis, that is, infected thrombosis of the portal vein and its branches is a rare condition with a high incidence of mortality and is often difficult to diagnose. We report two cases of suppurative pylephlebitis secondary to acute pancreatitis wherein the whole of the portal vein and its branches were transformed into an abscess cavity. The diagnosis was made after pus was seen coming out while the patient was taken up for portal vein thrombolysis. The pus was drained and the cavity was completely evacuated leading to recovery from this infection. These two cases highlight the fact that suppurative pylephlebitis is rare and extremely difficult to diagnose as it mimics portal vein thrombosis, but a high degree of suspicion in critically ill patients with thrombus-like appearance in portal vein having a uniform and homogeneous portal venous content on magnetic resonance imaging not responding to antibiotic therapy may be considered for aspiration for differentiating from thrombus and management.
Collapse
|
4
|
Garrett A, Carnish E, Das N, Slome M, Measley R. Once universally fatal: pylephlebitis. Am J Med 2014; 127:595-7. [PMID: 24508414 DOI: 10.1016/j.amjmed.2014.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Andrew Garrett
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia.
| | - Erin Carnish
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia
| | - Neha Das
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia
| | - Mary Slome
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert Measley
- Department of Medicine, Wilmington Veterans Affairs Medical Center, Wilmington, Del
| |
Collapse
|
5
|
Rustagi T, Uy EM, Rai M. Pyogenic liver abscesses secondary to pylephlebitis complicating acute on chronic pancreatitis. J Dig Dis 2012; 13:439-43. [PMID: 22788930 DOI: 10.1111/j.1751-2980.2012.00608.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Tarun Rustagi
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut 06032, USA.
| | | | | |
Collapse
|
6
|
|
7
|
Acute pylephlebitis following gastrointestinal infection: an unrecognized cause of septic shock. South Med J 2010; 103:956-9. [PMID: 20689494 DOI: 10.1097/smj.0b013e3181e63504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
Collapse
|
8
|
Kanellopoulou T, Alexopoulou A, Theodossiades G, Koskinas J, Archimandritis AJ. Pylephlebitis: an overview of non-cirrhotic cases and factors related to outcome. ACTA ACUST UNITED AC 2010; 42:804-11. [PMID: 20735334 DOI: 10.3109/00365548.2010.508464] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pylephlebitis is a condition with significant morbidity and mortality. We review herein 100 relevant case reports published since 1971. Eighty-one patients were reported with acute pylephlebitis, while the remaining patients had chronic pylephlebitis. The most common predisposing infections leading to pylephlebitis were diverticulitis and appendicitis. Cultures from blood or other tissues were positive in 77%. The infection was polymicrobial in half of the patients and the most common isolates were Bacteroides spp, Escherichia coli and Streptococcus spp. Thrombosis was extended to the superior mesenteric vein (SMV), splenic vein, and intrahepatic branches of the portal vein (PV) in 42%, 12%, and 39%, respectively. Antibiotics were administered in all and anticoagulation in 35 cases. Patients who received anticoagulation had a favourable outcome compared to those who received antibiotics alone (complete recanalization 25.7% vs 14.8% (p > 0.05), no recanalization 5.7% vs 22.2% (p < 0.05), and death 5.7% vs 22.2% (p < 0.01)). Cases with complete recanalization had prompt diagnosis and management and two-thirds were recently published. Nineteen patients died; the majority of these (73.7%) died over the period 1971-1990. In conclusion, pylephlebitis remains an entity with high morbidity and mortality, but modern imaging modalities have facilitated an earlier diagnosis and have improved the prognosis. Anticoagulation has a rather beneficial effect on patients with pylephlebitis.
Collapse
Affiliation(s)
- Theoni Kanellopoulou
- Second Department of Medicine, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | | | | | | | | |
Collapse
|
9
|
Hwang MW, Kim BN. Pylephlebitis: Report of a Case Secondary to Appendicitis and Review of Cases Reported in Korea. Infect Chemother 2010. [DOI: 10.3947/ic.2010.42.3.203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mee Won Hwang
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Baek-Nam Kim
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
[Liver abcess and biliary fistula as local complications of acute pancreatitis: approach and treatment]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:401-5. [PMID: 19473729 DOI: 10.1016/j.gastrohep.2009.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Accepted: 02/04/2009] [Indexed: 11/23/2022]
Abstract
Acute pancreatitis is frequently associated with the development of local complications: collections, necrosis, pseudocysts and abdominal abscesses. Although the development of liver abscesses has been linked to bile duct obstruction or abdominal surgery in patients with chronic pancreatitis, there are few descriptions of liver abscesses associated with an episode of acute pancreatitis. We report the case of a 45-year-old man with a first episode of severe acute alcoholic pancreatitis, complicated with thrombosis of the right portal branch, liver abscess and intrahepatic biliary fistula. The approach and treatment are described.
Collapse
|
11
|
Bogue CO, Leahy TR, Rea DJ, Bitnun A, Brandao LR, Kahr WHA, Jacobson S, Amaral JG, Connolly BL. Idiopathic Suppurative Pylephlebitis: Interventional Radiological Diagnosis and Management. Cardiovasc Intervent Radiol 2009; 32:1304-7. [DOI: 10.1007/s00270-009-9586-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 02/24/2009] [Accepted: 04/07/2009] [Indexed: 12/25/2022]
|
12
|
Nakagawa M, Ogino H, Shimohira M, Hara M, Shibamoto Y. Continuous regional arterial infusion therapy for acute necrotizing pancreatitis due to Mycoplasma pneumoniae infection in a child. Cardiovasc Intervent Radiol 2008; 32:581-4. [PMID: 18956223 DOI: 10.1007/s00270-008-9457-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 09/22/2008] [Accepted: 09/23/2008] [Indexed: 01/15/2023]
Abstract
A case of acute necrotizing pancreatitis due to Mycoplasma pneumoniae infection was treated in an 8-year-old girl. She experienced acute pancreatitis during treatment for M. pneumoniae. Contrast-enhanced computed tomographic scan revealed necrotizing pancreatitis. The computed tomographic severity index was 8 points (grade E). A protease inhibitor, ulinastatin, was provided via intravenous infusion but was ineffective. Continuous regional arterial infusion therapy was provided with gabexate mesilate (FOY-007, a protease inhibitor) and meropenem trihydrate, and the pancreatitis improved. This case suggests that infusion therapy is safe and useful in treating necrotizing pancreatitis in children.
Collapse
Affiliation(s)
- Motoo Nakagawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | | | | | | | | |
Collapse
|
13
|
Novellas S, Denys A, Bize P, Brunner P, Motamedi JP, Gugenheim J, Caroli FX, Chevallier P. Palliative portal vein stent placement in malignant and symptomatic extrinsic portal vein stenosis or occlusion. Cardiovasc Intervent Radiol 2008; 32:462-70. [PMID: 18956224 DOI: 10.1007/s00270-008-9455-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 09/10/2008] [Accepted: 09/12/2008] [Indexed: 02/07/2023]
Abstract
This article evaluates the results of portal vein (PV) stent placement in patients with malignant extrinsic lesions stenosing or obstructing the PV and causing symptomatic PV hypertension (PVHT). Fourteen patients with bile duct cancer (n = 7), pancreatic adenocarcinoma (n = 4), or another cancer (n = 3) underwent percutaneous transhepatic portal venous stent placement because of gastroesophageal or jejunal varices (n = 9), ascites (n = 7), and/or thrombocytopenia (n = 2). Concurrent tumoral obstruction of the main bile duct was treated via the transhepatic route in the same session in four patients. Changes in portal venous pressure, complications, stent patency, and survival were evaluated. Mean +/- standard deviation (SD) gradient of portal venous pressure decreased significantly immediately after stent placement from 11.2 mmHg +/- 4.6 to 1.1 mmHg +/- 1.0 (P < 0.00001). Three patients had minor complications, and one developed a liver abscess. During a mean +/- SD follow-up of 134.4 +/- 123.3 days, portal stents remained patent in 11 patients (78.6%); stent occlusion occurred in 3 patients, 2 of whom had undergone previous major hepatectomy. After stent placement, PVHT symptoms were relieved in four (57.1%) of seven patients who died (mean survival, 97 +/- 71.2 days), and relieved in six (85.7%) of seven patients still alive at the end of follow-up (mean follow-up, 171.7 +/- 153.5 days). Stent placement in the PV is feasible and relatively safe. It helped to relieve PVHT symptoms in a single session.
Collapse
Affiliation(s)
- Sébastien Novellas
- Department of Radiology and Interventional Radiology, Hôpital Archet, 151 route de Saint Antoine de Ginestière, 06202, Nice, France
| | | | | | | | | | | | | | | |
Collapse
|