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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-four adult patients with portomesenteric venous occlusion (PVO) were reviewed. In 11 with hepatic cirrhosis, PVO was usually heralded by worsening ascites often with varix hemorrhage; mortality was high. Four with isolated portal block had varix hemorrhage without ascites. All of these patients survived despite recurrent hematemesis when portal decompression was not feasible in two patients. Eight others (5 agnogenic and 3 with hypercoagulability), experienced sudden abdominal pain with a clot typically propagated into mesenteric tributaries with ileojejunal infarction; survival was related to the promptness of operation and the extent of bowel ischemia. Of five patients with intraabdominal sepsis and pylephlebitis, only one survived. In the final six patients, PVO occurred with intraabdominal carcinoma. Five had progressive ascites, cachexia, and an early death. Imaging techniques included plain and contrast roentgenograms, ultrasonography, and for definitive diagnosis direct portography (operative or splenoportogram), indirect portography (splanchnic arteriovenogram), and computed tomography. Thirteen of 34 patients had ascites, and in nine of 11 patients examined, protein concentration of ascitic fluid was extremely low (less than 0.6 g/dl). Clinical presentation of PVO varies, depending on acuteness and extent of visceral venous blockade, severity of portal hypertension, auxiliary venous collateralization, and regional lymph flow. Inciting factors include endothelial damage and blood hypercoagulability from trauma, infection, stagnant circulation, blood dyscrasia, and malignancy. Improved imaging now allows early diagnosis.
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PMID:Protean manifestations of pylethrombosis. A review of thirty-four patients. 387 12

Among 9,489 cholelithiasis autopsies the cases with cholecystectomy after 1970 significantly increased. At the same time the inflammatory complications with calculi (peritonitis, abscess, phlegmon, pylephlebitis, sepsis) became significantly more infrequent. But the remaining sequelae of calculi scarcely decreased, particularly not the lithogenic necroses of the pancreas and the non-suppurative cholangitis. After successful operation or conservative treatment many patients resume their old habits: but they are more endangered by dietary lapses and alcohol.
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PMID:[Was the prognosis of gallstone disease improved? Analysis of 9,489 cholelithiasis sections]. 408 83

We have reported the cases of two patients who had acute pylephlebitis associated with portal vein thrombosis and septic hepatic emboli as a result of right colonic diverticulitis. Although rare, pylephlebitis is a treatable but often lethal complication of intra-abdominal sepsis. Several bacterial pathogens, especially Escherichia coli are associated with pylephlebitis. Early suspicion and prompt antibiotic therapy can lead to resolution of portal vein thrombosis and hepatic abscess formation, resulting in full recovery for the patient. Surgery may not be required. Our two patients received ampicillin--the best first-line drug--until specific antibiotic therapy could be given. Early administration of a broad spectrum antibiotic is essential.
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PMID:Pylephlebitis associated with diverticulitis. 848 11

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.
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PMID:Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and management in the modern era. 858 30

Pylephlebitis usually occurs secondary to infection in the region drained by the portal venous system. A most common antesecent focus of infection is diverticulitis and the most common blood isolate is E. coli (54%), followed by Proteus mirabilis (23%). Overall mortality is 32% and most of the patients who had died had severe sepsis prior to the initiation of antibiotic therapy. We describe a case of pylephlebitis which had appendicitis and consequent septic thrombosis of the portal vein and its branches, with dissemination of infection to the liver. The patient had recovered due to timely antibiotic treatment alone and resulted in complete resolution. Early diagnosis and treatment are basic to a favorable clinical course.
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PMID:Pylephlebitis associated with appendicitis. 1006 17

Septic phlebitis of the portal vein, or pylephlebitis, is a rare but potentially severe complication of abdominal sepsis. The authors present a case of pylephlebitis after perforated retrocecal appendicitis in a child and discuss the etiology, presentation, diagnosis, and treatment of this disorder in the modern era.
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PMID:Pylephlebitis after appendicitis in a child. 1158 11

A man who developed profound septic shock was treated for Escherichia coli sepsis of unknown origin. Following stabilisation, a diagnosis of pylephlebitis (infection and thrombosis in the portal vein) was made at computed tomography. A review of the condition, its primary causes, typical features, investigation and management was presented.
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PMID:Unrecognized pylephlebitis causing life-threatening septic shock: a case report. 1564 Nov 59

Pylephlebitis or septic portal thrombophlebitis is a rare but serious condition which may occur following intra-abdominal sepsis from any source. Sigmoid diverticulitis is one of the most common sources. Modern imaging modalities, particularly CT, have increased the recognition of this condition. Standard treatment consists of anticoagulation plus antibiotic therapy to cover anaerobic and gram negative organisms. The duration of anticoagulation therapy remains controversial. Sigmoid colectomy may be required in cases of perforated diverticulitis or failure of medical therapy.
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PMID:[Pylephlebitis in the course of diverticulitis]. 1877 40

Pylephlebitis or septic thrombophlebitis of the portal vein is a rare entity with a high mortality rate. It is often a complication of intra-abdominal infection most commonly caused by diverticulitis and appendicitis. Diagnosis is often delayed since clinical signs and symptoms are nonspecific. Pylephlebitis should be considered in patients with sepsis due to gut-associated organisms without a clear focus of infection. We describe a patient with metastastatic colon carcinoma treated with chemotherapy and bevacizumab who was diagnosed with pylephlebitis after a duodenal ulcer and responded well to antibiotic treatment.
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PMID:Pylephlebitis after a duodenal ulcer in a patient with metastasised colon carcinoma treated with chemotherapy and bevacizumab: a case report. 1929 49

Portal vein thrombosis is a fairly common clinical condition that is usually not fatal but may give rise to serious complications. We report the case of a woman who was always in good health until the age of 50, when she developed acute gastroenterocolitis with inflammation of the portal vein (pylephlebitis or septic portal thrombophlebitis), resulting in thrombus formation, rupture of the vascular wall and exsanguination. At autopsy, no signs of thrombosis or inflammation were found elsewhere in the body and there was no evidence of any other disease or abnormality. Pylephlebitis may occur following intra-abdominal sepsis from any source. It is a rare condition that carries a high mortality. Rupture of the inflamed portal vein and possibly the adjacent artery is an extremely rare complication.
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PMID:Fatal hemorrhage due to thrombosis and rupture of the portal vein and hepatic artery. 1978 25


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