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Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report

INTRODUCTION AND IMPORTANCE: Pylephlebitis is a rare and life threatening thrombophlebitis of the portal vein. It commonly occurs following intra abdominal infections like appendicitis. It is even rarer in the pediatric age group. The nonspecific presentation impedes the diagnosis. Timely use of app...

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Autores principales: Pahari, Soumya, Shrestha, Manju, Basukala, Sunil, Kafle, Pooja, Rai, Kalpana, Khand, Yugant, Thapa, Ojas, Thapa, Anup
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9577868/
https://www.ncbi.nlm.nih.gov/pubmed/36268367
http://dx.doi.org/10.1016/j.amsu.2022.104744
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author Pahari, Soumya
Shrestha, Manju
Basukala, Sunil
Kafle, Pooja
Rai, Kalpana
Khand, Yugant
Thapa, Ojas
Thapa, Anup
author_facet Pahari, Soumya
Shrestha, Manju
Basukala, Sunil
Kafle, Pooja
Rai, Kalpana
Khand, Yugant
Thapa, Ojas
Thapa, Anup
author_sort Pahari, Soumya
collection PubMed
description INTRODUCTION AND IMPORTANCE: Pylephlebitis is a rare and life threatening thrombophlebitis of the portal vein. It commonly occurs following intra abdominal infections like appendicitis. It is even rarer in the pediatric age group. The nonspecific presentation impedes the diagnosis. Timely use of appropriate antibiotics and control of infection is paramount in its treatment and this case report highlights the same. CASE PRESENTATION: 11 year old female child from a rural area was referred from a local hospital for persistent fever and abdominal pain despite medical treatment. Workup revealed perforated appendicitis, pylephlebitis, and multiple liver abscess. She was successfully treated with appendicectomy followed by antibiotics and anticoagulants. CLINICAL DISCUSSION: Pylephlebitis secondary to appendicitis was frequently lethal in the pre-antibiotic era. Doppler ultrasonography and CT scan are the investigations of choice to establish the diagnosis by showing a thrombus in the portal vein. With use of antibiotics, early diagnosis by imaging and surgical control of the primary infection, appendicitis-associated-pylephlebitis now has improved outcomes. Larger scale studies are required to establish the role of anticoagulants. CONCLUSION: Early diagnosis and intervention of this fatal condition is life saving but numerous gaps exist in the literature regarding the treatment recommendation.
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spelling pubmed-95778682022-10-19 Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report Pahari, Soumya Shrestha, Manju Basukala, Sunil Kafle, Pooja Rai, Kalpana Khand, Yugant Thapa, Ojas Thapa, Anup Ann Med Surg (Lond) Case Report INTRODUCTION AND IMPORTANCE: Pylephlebitis is a rare and life threatening thrombophlebitis of the portal vein. It commonly occurs following intra abdominal infections like appendicitis. It is even rarer in the pediatric age group. The nonspecific presentation impedes the diagnosis. Timely use of appropriate antibiotics and control of infection is paramount in its treatment and this case report highlights the same. CASE PRESENTATION: 11 year old female child from a rural area was referred from a local hospital for persistent fever and abdominal pain despite medical treatment. Workup revealed perforated appendicitis, pylephlebitis, and multiple liver abscess. She was successfully treated with appendicectomy followed by antibiotics and anticoagulants. CLINICAL DISCUSSION: Pylephlebitis secondary to appendicitis was frequently lethal in the pre-antibiotic era. Doppler ultrasonography and CT scan are the investigations of choice to establish the diagnosis by showing a thrombus in the portal vein. With use of antibiotics, early diagnosis by imaging and surgical control of the primary infection, appendicitis-associated-pylephlebitis now has improved outcomes. Larger scale studies are required to establish the role of anticoagulants. CONCLUSION: Early diagnosis and intervention of this fatal condition is life saving but numerous gaps exist in the literature regarding the treatment recommendation. Elsevier 2022-09-23 /pmc/articles/PMC9577868/ /pubmed/36268367 http://dx.doi.org/10.1016/j.amsu.2022.104744 Text en © 2022 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Pahari, Soumya
Shrestha, Manju
Basukala, Sunil
Kafle, Pooja
Rai, Kalpana
Khand, Yugant
Thapa, Ojas
Thapa, Anup
Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report
title Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report
title_full Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report
title_fullStr Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report
title_full_unstemmed Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report
title_short Complicated pylephlebitis secondary to perforated appendicitis in a child- A rare case report
title_sort complicated pylephlebitis secondary to perforated appendicitis in a child- a rare case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9577868/
https://www.ncbi.nlm.nih.gov/pubmed/36268367
http://dx.doi.org/10.1016/j.amsu.2022.104744
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