Camacho-Aguilera José Francisco, Schlegelmilch González Martin Rosendo
Instituto Mexicano del Seguro Social, Hospital General de Zona No. 3, Servicio de Cirugía General. San Juan del Río, Querétaro, México.
Rev Med Inst Mex Seguro Soc. 2023 Jul 31;61(4):532-538. doi: 10.5281/zenodo.8200613.
The pilephlebitis is the septic thrombophlebitis of the portal venous system ranging from asymptomatic to severe complications. Diagnosed based on imaging tests, and their treatment is based on antibiotics and anticoagulant therapy.
24 years male, appendectomy 12 days before. Readmission for 3 days with fever, jaundice and choluria; hyperbilirrubinemia. Intravenous contrast CT is performed, showed thrombus in portal, splenic and mesenteric vein system. Diagnosis of pylephlebitis is established, initiating managed with antibiotics and anticoagulant, with favorable clinical outcome. The pylephlebitis has an estimated incidence of 2.7 cases per year, with an unspecified clinical picture ranging from asymptomatic to severe cases with septic shock and hepatic failure. There may be accompanying fever and abdominal pain in more than 80% of the cases and presenting in some cases with leukocytosis and hyperbilirrubinemia. Intravenous contrast CT is the gold standard. The treatment is based on 4 points: Septic focus control, antibiotics, early anticoagulant and resolution of complications.
The pylephlebitis should be taken into consideration as a possible secondary complication of intraabdominal infections. A timely diagnosis with a imaging tests and apply treatment reduce their morbidity and mortality.
门静脉炎是门静脉系统的化脓性血栓性静脉炎，症状从无症状到严重并发症不等。基于影像学检查进行诊断，其治疗基于抗生素和抗凝治疗。
一名24岁男性，12天前接受了阑尾切除术。因发热、黄疸和胆尿症再次入院3天；存在高胆红素血症。进行了静脉造影CT检查，显示门静脉、脾静脉和肠系膜静脉系统有血栓形成。确诊为门静脉炎，开始使用抗生素和抗凝剂进行治疗，临床结果良好。门静脉炎的估计发病率为每年2.7例，临床表现不明确，从无症状到伴有感染性休克和肝衰竭的严重病例不等。超过80%的病例可能伴有发热和腹痛，部分病例会出现白细胞增多和高胆红素血症。静脉造影CT是金标准。治疗基于四点：控制感染灶、使用抗生素、早期抗凝以及处理并发症。
门静脉炎应被视为腹腔内感染可能的继发性并发症。通过影像学检查及时诊断并进行治疗可降低其发病率和死亡率。
