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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.
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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
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Kim E, Byon I, Lee JJ, Seol YM, Kwon HJ, Park SW, Lee JE. Endogenous Endophthalmitis From a Klebsiella pneumoniae Liver Abscess: The Incidence, Risk Factors, and Utility of Imaging. Am J Ophthalmol 2023; 252:69-76. [PMID: 36963602 DOI: 10.1016/j.ajo.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE We investigated the rate of ophthalmologic examinations to detect endogenous endophthalmitis in patients with pyogenic liver abscesses (PLAs) and the incidence and risk factors of endophthalmitis from a PLA caused by Klebsiella pneumoniae (PLA-K). DESIGN Retrospective case series. METHODS A total of 536 patients admitted to a university hospital in Korea to treat PLAs during 2012-2022 were included. The proportion of patients who were referred for ophthalmologic examinations was investigated and the incidence of endophthalmitis in 248 patients with PLA-K was calculated. Univariate and multivariate logistic regression analyses were performed to define risk factors including demographic characteristics, underlying diseases, radiologic findings, and systemic conditions. RESULTS A comprehensive ophthalmologic examination was performed in 73.7% of all patients with PLAs, and the incidence of endophthalmitis from a PLA-K was 7.3%. A liver abscess >5 cm increased the incidence of endogenous endophthalmitis 4-fold compared with smaller abscesses (odds ratio [OR] = 4.01 [95% confidence interval {CI}, 1.02-15.78], P = .047) and portal or hepatic vein thrombophlebitis increased the incidence approximately 4-fold (OR = 4.04 [95% CI, 1.10-14.83], P = .036). Acute cholangitis was approximately 8-fold (OR = 8.33 [95% CI, 1.25-55.71], P = .029), and disseminated intravascular coagulation was approximately 6-fold (OR = 5.76 [95% CI, 1.22-27.21], P = .027) more related to prevalence of endophthalmitis. Other extrahepatic infections increased the incidence approximately 43-fold (OR = 43.06 [95% CI, 10.14-182.90], P < .001). CONCLUSIONS Clinicians should consider the risk of endogenous endophthalmitis when PLA-K patients have large liver abscesses (>5 cm), acute cholangitis, portal or hepatic vein thrombophlebitis, disseminated intravascular coagulation, or other extrahepatic infections.
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Affiliation(s)
- EunAh Kim
- Department of Ophthalmology (E.K., I.B., H.J.K., S.W.P., J.E.L.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea; Department of Ophthalmology (E.K.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
| | - Iksoo Byon
- Department of Ophthalmology (E.K., I.B., H.J.K., S.W.P., J.E.L.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | | | - Young Mi Seol
- Department of Internal Medicine (Y.M.S.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Han Jo Kwon
- Department of Ophthalmology (E.K., I.B., H.J.K., S.W.P., J.E.L.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sung Who Park
- Department of Ophthalmology (E.K., I.B., H.J.K., S.W.P., J.E.L.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology (E.K., I.B., H.J.K., S.W.P., J.E.L.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea; Lee Eye Clinic (J.E.L.), Busan, South Korea
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Cheikh Youssef R, Jacques JM, Zahir S, Roger T, Landen S. Portal-Mesenteric Suppurative Emphysematous Pylephlebitis: A Case Report. Cureus 2023; 15:e41693. [PMID: 37575871 PMCID: PMC10413925 DOI: 10.7759/cureus.41693] [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] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Suppurative thrombophlebitis of the portal-mesenteric venous system occurring in the setting of abdominal inflammatory and infectious processes is a serious condition that can lead to septic shock, bowel ischemia, hepatic abscess, and death if unrecognized. Diagnosis is often delayed because symptoms are aspecific and pain at the primary site of infection may be mild. Contrast-enhanced CT scans can diagnose both portal thrombosis and a primary infection site. Treatment may include early resective surgery in case of appendicitis or diverticulitis, in association with large-spectrum antibiotics and possibly anticoagulation. A characteristic of suppurative thrombophlebitis, whether splanchnic or systemic, is the latency before the effects of antibiotic therapy are seen. Anticoagulation can be administered to avoid extension to the superior mesenteric vein. We presented a critically ill 53-year-old man with chronic colonic diverticulitis complicated by suppurative emphysematous portal-mesenteric thrombophlebitis with only a slow response to large-spectrum antibiotics.
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Affiliation(s)
- Rida Cheikh Youssef
- Department of Emergency Medicine and Critical Care Unit, Delta Chirec Hospital, Brussels, BEL
| | | | - Soheil Zahir
- Department of Emergency Medicine, Centre Hospitalier Régional Sambre et Meuse, Sambreville, BEL
| | - Thierry Roger
- Department of Radiology, Delta Chirec Hospital, Brussels, BEL
| | - Serge Landen
- Department of Surgery, Delta Chirec Hospital, Brussels, BEL
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4
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Miyamoto H. Minimally Invasive Treatment for Advanced Hemorrhoids. J Anus Rectum Colon 2023; 7:8-16. [PMID: 36743466 PMCID: PMC9876604 DOI: 10.23922/jarc.2022-068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023] Open
Abstract
Hemorrhoids, the most common anorectal disease, give rise to symptoms such as bleeding, prolapse, and pruritus. The treatment for advanced hemorrhoids (Grade III or IV) is gradually shifting toward minimally invasive procedures. These procedures focus on reduction of blood flow in hemorrhoids. Conventional hemorrhoidectomy (CH), also known as Milligan-Morgan or Ferguson hemorrhoidectomy, is considered as the standard treatment for Grade III and IV hemorrhoids because it achieves the lowest recurrence rate. Over the years, alternative minimally invasive techniques such as stapled hemorrhoidopexy and transanal hemorrhoidal dearterialization (THD) have been developed. A new, effective sclerosant, aluminum potassium sulfate and tannic acid (ALTA), has been developed in Japan and has been used for all grades of hemorrhoids; however, its effectiveness declines over time. Other minimally invasive, nonsurgical procedures, including rubber band ligation, endoscopic injection sclerotherapy, and infrared coagulation, have also been performed for Grade III hemorrhoids. Those minimally invasive treatments improve bleeding and prolapse and are highly recommended for patients who are unfit for CH. THD with mucopexy or ALTA sclerotherapy has also been performed for Grade IV hemorrhoids. However, the recurrence rate after ALTA sclerotherapy for Grade IV hemorrhoids was higher than that for Grade III lesions in our case study. In conclusion, minimally invasive treatments are a valid alternative for patients with advanced hemorrhoids after clear explanation of recurrence rates and possible complications.
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Dalmau M, Petrola C, Lopez P, Vilallonga R, Garcia Ruiz de Gordejuela A, Armengol M. A case of pylephlebitis complicating an acute appendicitis: Uncommon cholangitis-like situation. Int J Surg Case Rep 2022; 99:107657. [PMID: 36162358 PMCID: PMC9568782 DOI: 10.1016/j.ijscr.2022.107657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/11/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Pylephlebitis represents an uncommon but serious condition with significant mortality which can complicate intrabdominal sepsis of any etiology. One of the most common predisposing infections is appendicitis. Presentation of case A 21-year-old male with 4 days of epigastric and right upper quadrant pain with associated fever and chills with hyperbilirubinemia and leukocytosis in blood test was orientated as cholangitis at first diagnostic. Poor response to antibiotic treatment with persistent fever and bacteriemia with E. coli and S. constellatus isolated in blood cultures led to complete the study with a CT scan which revealed an acute appendicitis complicated with thrombosis of the superior mesenteric vein (SMV) up to the splenoportal confluence. Appendectomy, treatment with broad-spectrum antibiotic and anticoagulation treatment led to full recovery. Follow-up after 6 months showed almost complete SMV patency. Discussion Pylephlebitis can present as a clinical cholangitis-like picture with hyperbilirubinemia with or without liver abscess formation. CT scan seems to be the most sensitive diagnostic test as it identifies the underlying focus of infection, the extension of the thrombosis and detects liver abscesses. Surgical removal of the source of infection as appendectomy and adequate antibiotic treatment adjusted by culture should be initiated promptly. Anticoagulant treatment should be considered in the case of poor clinical outcome or thrombosis progression. Conclusion Pylephlebitis should be suspected mainly in patients with appendicitis and diverticulitis with erratic behavior despite surgical removal and/or antibiotic treatment with abnormal liver tests and persistent bacteriemia. CT scan is the preferred image study. Pylephlebitis represents an uncommon but serious condition. Main cause has to be extensively investigated. Appendicitis is a potential cause of pylephlebitis. Pylephlebitis should be suspected mainly in patients with appendicitis and diverticulitis with erratic behavior.
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6
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Peeters M, De Raeymaeker X, Karimi A, van der Pas M. Pyogenic liver abscess after open hemorrhoidectomy. Acta Chir Belg 2022:1-4. [PMID: 34968166 DOI: 10.1080/00015458.2021.2024694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Surgical excision of hemorrhoids remains the gold standard for patients who have grade III or IV hemorrhoids. The complication rate is low and success rate is high. In this case, we describe a 44-year-old male with septic shock and small liver abscesses as a rare complication after Milligan-Morgan hemorrhoidectomy. METHODS In this case report, we describe the case of a patient with septic shock and small liver abscesses as a rare complication after Milligan-Morgan hemorrhoidectomy. A search in the PubMed database showed only three publications describing patients with liver abscesses after hemorrhoidectomy and some more cases after rubber band ligation. RESULTS The patient was admitted at the intensive care unit and received intravenous antibiotics. He could leave the hospital in good condition after 17 days. He received antibiotics for six weeks in total. CONCLUSION Pyogenic liver abscess after open hemorrhoidectomy is a rare complication after Milligan-Morgan hemorrhoidectomy and rubber band ligation. Pyogenic liver abscesses can be treated with antibiotics, sometimes associated with percutaneous drainage or surgeryIn patients with predisposing factors prophylactic use of antibiotics could be considered on a case-by-case basis.
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Affiliation(s)
- Maxim Peeters
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | | | - Amine Karimi
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
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7
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Anand S, Umeh CA, Giberson C, Wassel E, Nguyen A, Porter H, Choday P, Kaur H, Kundu A, Penaherrera J. Septic Portal Vein Thrombosis, Clinical Presentation, and Management. Cureus 2021; 13:e19840. [PMID: 34963853 PMCID: PMC8702393 DOI: 10.7759/cureus.19840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/17/2022] Open
Abstract
Pylephlebitis, otherwise known as septic portal vein thrombosis, is an infective suppurative thrombosis of the portal vein and/or its intra-hepatic branches. It is a diagnosis that is frequently missed but easily treated with antibiotics. Therefore, it should be considered early on in any patient presenting with fever, abdominal pain, leukocytosis, and evidence of portal vein thrombosis on a CT scan. In this case report, we discuss a case of pylephlebitis as well as the etiologies, diagnosis, and treatment of septic portal vein thrombosis.
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Affiliation(s)
- Simran Anand
- Internal Medicine, St. George's University School of Medicine, True Blue, GRD.,Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | | | | | - Elias Wassel
- Internal Medicine, St. George's University School of Medicine, True Blue, GRD.,Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | - Anphong Nguyen
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | | | - Prithi Choday
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | - Harpreet Kaur
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | - Ankur Kundu
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
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8
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Xu M, Russell M, Lin A, Yoo J. Pyogenic Liver Abscess as a Complication of Internal Hemorrhoid Banding. Am Surg 2020. [DOI: 10.1177/000313481408000201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Mu Xu
- Department of Surgery UCLA Medical Center Los Angeles California
| | - Marcia Russell
- Department of Surgery UCLA Medical Center Los Angeles California
| | - Anne Lin
- Department of Surgery UCLA Medical Center Los Angeles California
| | - James Yoo
- Department of Surgery UCLA Medical Center Los Angeles California
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9
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Gallo G, Martellucci J, Sturiale A, Clerico G, Milito G, Marino F, Cocorullo G, Giordano P, Mistrangelo M, Trompetto M. Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease. Tech Coloproctol 2020; 24:145-164. [PMID: 31993837 PMCID: PMC7005095 DOI: 10.1007/s10151-020-02149-1] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
Hemorrhoidal disease (HD) is the most common proctological disease in the Western countries. However, its real prevalence is underestimated due to the frequent self-medication.The aim of this consensus statement is to provide evidence-based data to allow an individualized and appropriate management and treatment of HD. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL, and EMBASE.These guidelines are inclusive and not prescriptive.The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by American College of Chest Physicians. The recommendations were graded A, B, and C.
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Affiliation(s)
- G Gallo
- Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - J Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - A Sturiale
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - G Clerico
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - G Milito
- Department of General Surgery, Tor Vergata University, Rome, Italy
| | - F Marino
- Operative Unit of General Surgery, IRCCS de Bellis, Castellana Grotte, Bari, Italy
| | - G Cocorullo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - P Giordano
- Department of Colorectal Surgery, Whipps Cross University Hospital, Barts Health, London, UK
| | - M Mistrangelo
- Department of General and Minimally Invasive Surgery, University of Turin, Turin, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
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10
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Fowler GE, Siddiqui J, Zahid A, Young CJ. Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand. World J Clin Cases 2019; 7:3742-3750. [PMID: 31799299 PMCID: PMC6887603 DOI: 10.12998/wjcc.v7.i22.3742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/21/2019] [Accepted: 10/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hemorrhoidal disease is the most common anorectal disorder. Hemorrhoids can be classified as external or internal, according to their relation to the dentate line. External hemorrhoids originate below the dentate line and are managed conservatively unless the patient cannot keep the perianal region clean, or they cause significant discomfort. Internal hemorrhoids originate above the dentate line and can be managed according to the graded degree of prolapse, as described by Goligher. Generally, low-grade internal hemorrhoids are effectively treated conservatively, by non-operative measures, while high-grade internal hemorrhoids warrant procedural intervention.
AIM To determine the application of clinical practice guidelines for the current management of hemorrhoids and colorectal surgeon consensus in Australia and New Zealand.
METHODS An online survey was distributed to 206 colorectal surgeons in Australia and New Zealand using 17 guideline-based hypothetical clinical scenarios.
RESULTS There were 82 respondents (40%) to 17 guideline-based scenarios. Nine (53%) reached consensus, of which only 1 (6%) disagreed with the guidelines. This was based on low quality evidence for the management of acutely thrombosed external hemorrhoids. There were 8 scenarios which showed community equipoise (47%) and they were equally divided for agreeing or disagreeing with the guidelines. These topics were based on low and moderate levels of evidence. They included the initial management of grade I internal hemorrhoids, grade III internal hemorrhoids when initial management had failed and the patient had recognised risks factors for septic complications; and finally, the decision-making when considering patient preferences, including a prompt return to work, or minimal post-operative pain.
CONCLUSION Although there are areas of consensus in the management of hemorrhoids, there are many areas of community equipoise which would benefit from further research.
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Affiliation(s)
- George E Fowler
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, United Kingdom
| | - Javariah Siddiqui
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Newtown 2042, NSW, Australia
| | - Assad Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Newtown 2042, NSW, Australia
| | - Christopher John Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Newtown 2042, NSW, Australia
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Abstract
Pylephlebitis is a thrombophlebitis of the portal vein or its branches, which usually occurs as a complication of intra-abdominal infections that are drained by the portal vein, most commonly as a result of diverticulitis or appendicitis. Diagnosis of pylephlebitis is achieved by visualizing a portal vein thrombosis in a patient with bacteremia or a recent intra-abdominal infection. Many microorganisms have been reported to cause this infection. However, Actinomyces has never been reported before as a cause of pylephlebitis. Here, we describe a case of a 56-year-old female who had pylephlebitis that was caused by Actinomyces bacteremia and was treated with intravenous antibiotics.
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Affiliation(s)
- Omar Abughanimeh
- Internal Medicine, Kansas City School of Medicine, Kansas City, USA
| | - Mohammad Tahboub
- Internal Medicine, University of Missouri at Kansas City, Kansas City, USA
| | - Yousaf Zafar
- Internal Medicine, University of Missouri Kansas City, Kansas City, USA
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12
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Nazir S, Jehangir A, Siddiqui A, Tachamo N, Lohani S, York E. A rare case of pylephlebitis after colonic polypectomy. J Community Hosp Intern Med Perspect 2017. [PMID: 28634524 PMCID: PMC5463667 DOI: 10.1080/20009666.2017.1288955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pylephlebitis or infective suppurative thrombosis of the portal mesenteric venous system is an uncommon condition that can potentially be deadly if not recognized and treated early. Although most commonly associated with pancreatitis and diverticulitis, any intra-abdominal or pelvic infection occurring in the region drained by the portal venous system can cause this rare entity. We report a case of a 75-year-old woman who developed post polypectomy pylephlebitis following colonoscopy, a condition rarely reported in the literature.
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Affiliation(s)
- Salik Nazir
- Department of Internal Medicine, Reading Hospital & Medical Center, West Reading, PA, USA
| | - Asad Jehangir
- Department of Internal Medicine, Reading Hospital & Medical Center, West Reading, PA, USA
| | - Anam Siddiqui
- Department of Medicine, South City Hospital, Karachi, Pakistan
| | - Niranjan Tachamo
- Department of Internal Medicine, Reading Hospital & Medical Center, West Reading, PA, USA
| | - Saroj Lohani
- Department of Internal Medicine, Reading Hospital & Medical Center, West Reading, PA, USA
| | - Eugene York
- Department of Internal Medicine, Reading Hospital & Medical Center, West Reading, PA, USA
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13
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COCORULLO G, TUTINO R, FALCO N, LICARI L, ORLANDO G, FONTANA T, RASPANTI C, SALAMONE G, SCERRINO G, GALLO G, TROMPETTO M, GULOTTA G. The non-surgical management for hemorrhoidal disease. A systematic review. G Chir 2017; 38:5-14. [PMID: 28460197 PMCID: PMC5730401 DOI: 10.11138/gchir/2017.38.1.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The non-surgical treatments for hemorrhoids are cost and time-saving techniques usually performed in patients suffering early hemorrhoidal disease. The most used are rubber band ligation (RBL), injection sclerotherapy (IS), and infrared coagulation (IRC). We performed a systematic review in order to evaluate: do these procedures really help to avoid further more aggressive treatments? What are the common harms? What are the rare harms? How many recurrences there are? A total of 21 RCTs were included in this review: 12 on RBL, 4 on IRC and 5 on IS. In RBL bleeding stops in up to 90% and III degree hemorrhoids improves in 78%-83.8%. IV degree prolapse should have a more invasive treatment. The commonest complications are bleeding and pain (8-80%). IRC related improvement is 78%, 51% and 22% for I, II and III degree. Post-operative pain occurs in 15-100% and post-operative bleeding ranges from 15% to 44%. Recurrence rate is 13% at a three months follow-up. IS brings to the resolution of prolapse in 90%-100% of II degree and allows good results for III degree even if reported only by case series. The post-procedural pain is 36%-49%. Bleeding is a very rare harm. Even if not definitive, these treatments could be an alternative for mild symptomatic patients after a clear explanation of recurrence rates and possible complications.
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Affiliation(s)
- G. COCORULLO
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, General Surgery and Emergency Operative Unit, “Policlinico Universitario P. Giaccone”, Palermo, Italy
| | - R. TUTINO
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, General Surgery and Emergency Operative Unit, “Policlinico Universitario P. Giaccone”, Palermo, Italy
| | - N. FALCO
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, General Surgery and Emergency Operative Unit, “Policlinico Universitario P. Giaccone”, Palermo, Italy
| | - L. LICARI
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, General Surgery and Emergency Operative Unit, “Policlinico Universitario P. Giaccone”, Palermo, Italy
| | - G. ORLANDO
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, General Surgery and Emergency Operative Unit, “Policlinico Universitario P. Giaccone”, Palermo, Italy
| | - T. FONTANA
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, General Surgery and Emergency Operative Unit, “Policlinico Universitario P. Giaccone”, Palermo, Italy
| | - C. RASPANTI
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, General Surgery and Emergency Operative Unit, “Policlinico Universitario P. Giaccone”, Palermo, Italy
| | - G. SALAMONE
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, General Surgery and Emergency Operative Unit, “Policlinico Universitario P. Giaccone”, Palermo, Italy
| | - G. SCERRINO
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, General Surgery and Emergency Operative Unit, “Policlinico Universitario P. Giaccone”, Palermo, Italy
| | - G. GALLO
- Colo-proctology Unit, “Policlinico di Monza - Clinica Santa Rita”, Vercelli, Italy
| | - M. TROMPETTO
- Colo-proctology Unit, “Policlinico di Monza - Clinica Santa Rita”, Vercelli, Italy
| | - G. GULOTTA
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, General Surgery and Emergency Operative Unit, “Policlinico Universitario P. Giaccone”, Palermo, Italy
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14
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Albuquerque A. Rubber band ligation of hemorrhoids: A guide for complications. World J Gastrointest Surg 2016; 8:614-620. [PMID: 27721924 PMCID: PMC5037334 DOI: 10.4240/wjgs.v8.i9.614] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/26/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
Rubber band ligation is one of the most important, cost-effective and commonly used treatments for internal hemorrhoids. Different technical approaches were developed mainly to improve efficacy and safety. The technique can be employed using an endoscope with forward-view or retroflexion or without an endoscope, using a suction elastic band ligator or a forceps ligator. Single or multiple ligations can be performed in a single session. Local anaesthetic after ligation can also be used to reduce the post-procedure pain. Mild bleeding, pain, vaso-vagal symptoms, slippage of bands, priapism, difficulty in urination, anal fissure, and chronic longitudinal ulcers are normally considered minor complications, more frequently encountered. Massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention needing catheterization, pelvic sepsis and death are uncommon major complications. Mild pain after rubber band ligation is the most common complication with a high frequency in some studies. Secondary bleeding normally occurs 10 to 14 d after banding and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, with some reports of massive life-threatening haemorrhage. Several infectious complications have also been reported including pelvic sepsis, Fournier’s gangrene, liver abscesses, tetanus and bacterial endocarditis. To date, seven deaths due to these infectious complications were described. Early recognition and immediate treatment of complications are fundamental for a favourable prognosis.
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Choudhry AJ, Baghdadi YMK, Amr MA, Alzghari MJ, Jenkins DH, Zielinski MD. Pylephlebitis: a Review of 95 Cases. J Gastrointest Surg 2016; 20:656-61. [PMID: 26160320 PMCID: PMC4882085 DOI: 10.1007/s11605-015-2875-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023]
Abstract
Pylephlebitis, or suppurative thrombophlebitis of the portal mesenteric venous system occurring in the setting of abdominal inflammatory processes, is a rare but deadly disease commonly associated with diverticulitis. We review our institutional experience in the management of patients with this condition. A retrospective review of medical records from 2002 to 2012 was performed. Patients with a portal mesenteric vein thrombosis (PMVT) within 30 days of an intra-abdominal inflammatory process were identified and evaluated. Ninety-five patients were included. The mean patient age at presentation was 57 years (range, 24-88). The most common associated processes were pancreatitis (31 %), followed by diverticulitis (19 %). Bacteremia was noted in 34 (44 %) patients. The most common organism cultured was Streptococcus viridans. Antibiotic and anticoagulation therapy was given in 86 (91 %) and 78 (82 %) patients, respectively. Overall, we report an 11 % mortality rate. Albeit rare, pylephlebitis most commonly was manifested in the setting of pancreatitis. Treatment should be individualized to culture results and extent of thrombosis. If diagnosed early and managed appropriately, a favorable outcome is possible.
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Affiliation(s)
| | | | | | | | | | - Martin D. Zielinski
- Department of Surgery, Mayo Clinic, Rochester, MN, USA,Division of Trauma, Critical Care, and General Surgery, Rochester, MN, USA
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Trompetto M, Clerico G, Cocorullo GF, Giordano P, Marino F, Martellucci J, Milito G, Mistrangelo M, Ratto C. Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement. Tech Coloproctol 2015; 19:567-75. [PMID: 26403234 DOI: 10.1007/s10151-015-1371-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/05/2015] [Indexed: 02/07/2023]
Abstract
Hemorrhoids are one of the most common medical and surgical diseases and the main reason for a visit to a coloproctologist. This consensus statement was drawn up by the Italian society of colorectal surgery in order to provide practice parameters for an accurate assessment of the disease and consequent appropriate treatment. The authors made a careful search in the main databases (MEDLINE, PubMed, Embase and Cochrane), and all results were classified on the basis of the grade of recommendation (A-C) of the American College of Chest Physicians.
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Affiliation(s)
- M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.
| | - G Clerico
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G F Cocorullo
- Unit of Emergency and General Surgery, Department of Surgical Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - P Giordano
- Department of Colorectal Surgery, Barts Health, London, UK
| | - F Marino
- Department of General Surgery, "A. Perrino" Hospital, Brindisi, Italy
| | - J Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Milito
- Department of General Surgery, Tor Vergata University, Rome, Italy
| | - M Mistrangelo
- Department of General and Minimally Invasive Surgery, University of Turin, Turin, Italy
| | - C Ratto
- Proctology Unit, University Hospital "A Gemelli", Catholic University, Rome, Italy
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Berkel AEM, Witte ME, Koop R, Hendrix MGR, Klaase JM. Brain abscess after transanal hemorrhoidal dearterialization: a case report. Case Rep Gastroenterol 2013; 7:208-13. [PMID: 23741208 PMCID: PMC3670629 DOI: 10.1159/000351817] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A relatively new therapy in the treatment of hemorrhoids is transanal hemorrhoidal dearterialization (THD). We report a case of brain abscess caused by Streptococcus milleri following THD. Although a brain abscess after drainage of a perianal abscess has been described in the literature, no report exists of a brain abscess following treatment of hemorrhoids. A healthy 51-year-old man with hemorrhoids underwent THD. Two weeks later he presented with a headache, bradyphrenia, flattened behavior and a left hemiplegia. No perianal complaint and/or perianal abscess was present. A contrast CT scan of the cerebrum showed a right temporoparieto-occipital abscess, with edema and compression of the surrounding tissue and lateral ventricles. MRI showed an abscess with leakage in the right lateral ventricle. Treatment with dexamethasone and intravenous antibiotics was started. Because of progression of symptoms, 3 weeks later ventriculoscopy was performed and the abscess was drained. Culture of the punctuate showed S. milleri. Because of developing hydrocephalus 3 days after ventriculoscopy, first an external ventricle drain and later a ventriculoperitoneal drain was placed. Hereafter the hemiplegia and cognitive disorders improved. This case report describes a severe complication following treatment of hemorrhoids with THD which until now, to our knowledge, has never been described in the literature.
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Affiliation(s)
- A E M Berkel
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
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18
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Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY. Klebsiella pneumoniae liver abscess: a new invasive syndrome. THE LANCET. INFECTIOUS DISEASES 2013; 12:881-7. [PMID: 23099082 DOI: 10.1016/s1473-3099(12)70205-0] [Citation(s) in RCA: 522] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Klebsiella pneumoniae is a well known human nosocomial pathogen. Most community-acquired K pneumoniae infections cause pneumonia or urinary tract infections. During the past two decades, however, a distinct invasive syndrome that causes liver abscesses has been increasingly reported in Asia, and this syndrome is emerging as a global disease. In this Review, we summarise the clinical presentation and management as well the microbiological aspects of this invasive disease. Diabetes mellitus and two specific capsular types in the bacterium predispose a patient to the development of liver abscesses and the following metastatic complications: bacteraemia, meningitis, endophthalmitis, and necrotising fasciitis. For patients with this invasive syndrome, appropriate antimicrobial treatment combined with percutaneous drainage of liver abscesses increases their chances of survival. Rapid detection of the hypervirulent strain that causes this syndrome allows earlier diagnosis and treatment, thus minimising the occurrence of sequelae and improving clinical outcomes.
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Affiliation(s)
- L Kristopher Siu
- Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
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19
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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.
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20
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[Portal vein thrombosis associated with biliary tract infection]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:644-8. [PMID: 22609347 DOI: 10.1016/j.gastrohep.2012.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 03/13/2012] [Accepted: 03/21/2012] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the etiology, symptoms and management of portal vein thrombosis associated with biliary tract infection and to compare our findings with classical causes of pylephlebitis. MATERIAL AND METHODS We performed a retrospective descriptive study of 10 patients in a tertiary hospital. RESULTS Portal vein thrombosis was associated with biliary tract infection in seven patients and with classical causes of pylephlebitis in three. In both groups, symptoms consisted of fever and abdominal pain accompanied by leukocytosis and increased liver enzymes. Blood cultures were positive in most patients and the main complication was liver abscess. The therapeutic management and outcomes were similar in both groups. CONCLUSIONS Portal vein thrombosis can be associated with biliary tract infection. Clinical presentation and outcomes are highly similar to those in classical causes of pylephlebitis.
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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
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Affiliation(s)
- Austin G Acheson
- Section of Gastrointestinal Surgery, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH.
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