Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein
Thrombophlebitis of the portal vein (pylephlebitis) is a rare but serious condition with a high mortality rate of 11-50%. A 56-year-old male patient presented with a two-day history of postprandial, colic-like epigastric pain, nausea, fever, chills, and diarrhea. Clinical workup showed peritonism, l...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2020/2343218 |
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| author | Julia Bockmeyer Stephanie Taha-Mehlitz Nickolaus Heeren Stefan Ristic Jürg Metzger Jörn-Markus Gass |
| author_facet | Julia Bockmeyer Stephanie Taha-Mehlitz Nickolaus Heeren Stefan Ristic Jürg Metzger Jörn-Markus Gass |
| author_sort | Julia Bockmeyer |
| collection | DOAJ |
| description | Thrombophlebitis of the portal vein (pylephlebitis) is a rare but serious condition with a high mortality rate of 11-50%. A 56-year-old male patient presented with a two-day history of postprandial, colic-like epigastric pain, nausea, fever, chills, and diarrhea. Clinical workup showed peritonism, leukocytosis, and elevated C-reactive protein (CRP). A computed tomography (CT) scan revealed a long-segment, partial thrombosis of the superior mesenteric vein as well as gas in the portal venous system. Additionally, extensive jejunal diverticulosis was present. Pylephlebitis mostly results from intestinal infections, e.g., appendicitis or diverticulitis. We assumed that the patient had suffered from a self-limiting episode of jejunal diverticulitis leading to septic thrombosis. Initially, antibiotic therapy and anticoagulation with heparin were administered. The patient deteriorated, and due to increasing abdominal defense, fever, and hypotension, a diagnostic laparoscopy was performed. Bowel ischemia could be ruled out, and after changing antibiotic therapy, the patient’s condition improved. He was discharged without any further complications and without complaints on day 13. An underlying coagulopathy like myeloproliferative neoplasm or antiphospholipid syndrome could be ruled out. |
| format | Article |
| id | doaj-art-84024023b06e47388ae9c320b2012254 |
| institution | Kabale University |
| issn | 2090-6900 2090-6919 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Surgery |
| spelling | doaj-art-84024023b06e47388ae9c320b20122542025-02-03T06:46:40ZengWileyCase Reports in Surgery2090-69002090-69192020-01-01202010.1155/2020/23432182343218Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric VeinJulia Bockmeyer0Stephanie Taha-Mehlitz1Nickolaus Heeren2Stefan Ristic3Jürg Metzger4Jörn-Markus Gass5Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, SwitzerlandClarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel Kleinriehenstrasse 30 4058, SwitzerlandDepartment of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, SwitzerlandDepartment of General Surgery, Cantonal Hospital of Nidwalden, Ennetmooserstrasse, 6370 Stans, SwitzerlandDepartment of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, SwitzerlandDepartment of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, SwitzerlandThrombophlebitis of the portal vein (pylephlebitis) is a rare but serious condition with a high mortality rate of 11-50%. A 56-year-old male patient presented with a two-day history of postprandial, colic-like epigastric pain, nausea, fever, chills, and diarrhea. Clinical workup showed peritonism, leukocytosis, and elevated C-reactive protein (CRP). A computed tomography (CT) scan revealed a long-segment, partial thrombosis of the superior mesenteric vein as well as gas in the portal venous system. Additionally, extensive jejunal diverticulosis was present. Pylephlebitis mostly results from intestinal infections, e.g., appendicitis or diverticulitis. We assumed that the patient had suffered from a self-limiting episode of jejunal diverticulitis leading to septic thrombosis. Initially, antibiotic therapy and anticoagulation with heparin were administered. The patient deteriorated, and due to increasing abdominal defense, fever, and hypotension, a diagnostic laparoscopy was performed. Bowel ischemia could be ruled out, and after changing antibiotic therapy, the patient’s condition improved. He was discharged without any further complications and without complaints on day 13. An underlying coagulopathy like myeloproliferative neoplasm or antiphospholipid syndrome could be ruled out.http://dx.doi.org/10.1155/2020/2343218 |
| spellingShingle | Julia Bockmeyer Stephanie Taha-Mehlitz Nickolaus Heeren Stefan Ristic Jürg Metzger Jörn-Markus Gass Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein Case Reports in Surgery |
| title | Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein |
| title_full | Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein |
| title_fullStr | Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein |
| title_full_unstemmed | Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein |
| title_short | Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein |
| title_sort | jejunal diverticulosis probably leading to pylephlebitis of the superior mesenteric vein |
| url | http://dx.doi.org/10.1155/2020/2343218 |
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