Plemmons R M, Dooley D P, Longfield R N
Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA.
Clin Infect Dis. 1995 Nov;21(5):1114-20. doi: 10.1093/clinids/21.5.1114.
Pylephlebitis usually occurs secondary to infection in the region drained by the portal venous system. We describe a case of pylephlebitis at our institution and examine 18 other cases culled from the literature since 1979, reviewing diagnostic and management issues. A precipitating focus of infection (most commonly diverticulitis) was identified in 13 (68%) of the cases. Bacteremia (often polymicrobial) was present in 88% of the patients. The most common blood isolate was Bacteroides fragilis. Overall mortality was 32%, but most of the patients who died had severe sepsis prior to the initiation of antibiotic therapy. In no case was improvement in a patient's clinical status clearly attributable to the use of heparin, but some beneficial effect of anticoagulation could not be ruled out. This report is the first to examine the published experience with pylephlebitis during the era of antibiotics and modern imaging and is also the first to review critically the role of anticoagulation in the management of this disease.
门静脉炎通常继发于门静脉系统引流区域的感染。我们描述了我院的一例门静脉炎病例，并研究了自1979年以来从文献中收集的其他18例病例，回顾了诊断和管理问题。13例（68%）病例中发现了感染的诱发灶（最常见的是憩室炎）。88%的患者存在菌血症（通常为多种微生物感染）。最常见的血液分离菌是脆弱拟杆菌。总体死亡率为32%，但大多数死亡患者在开始抗生素治疗前就已患有严重脓毒症。在任何病例中，患者临床状况的改善都未明确归因于肝素的使用，但不能排除抗凝的一些有益作用。本报告首次审视了抗生素时代和现代影像学时代门静脉炎的已发表经验，也是首次批判性地回顾抗凝在该病管理中的作用。
