Pylephlebitis associated with acute infected choledocholithiasis

Yu-Tzu Tsao; Shih-Hua Lin; Chih-Jen Cheng; Feng-Yee Chang

doi:10.1097/00000441-200608000-00006

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Pylephlebitis associated with acute infected choledocholithiasis

Journal article

Peer reviewed

Pylephlebitis associated with acute infected choledocholithiasis

Yu-Tzu Tsao, Shih-Hua Lin, Chih-Jen Cheng and Feng-Yee Chang

The American journal of the medical sciences, Vol.332(2), pp.85-87

08/01/2006

DOI: 10.1097/00000441-200608000-00006

PMID: 16909055

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Abstract

Pylephlebitis, also called septic thrombophlebitis of the portal vein, is a life-threatening complication of intra-abdominal infection. Although rare, it remains a less recognized entity with a high rate of mortality. We present a 66-year-old man with acute infected choledocholithiasis complicated with Bacteroides fragilis bacteremia. The contrast-enhanced computed tomography scan of the abdomen showed nearly total thrombotic occlusion of the left portal vein. The comprehensive studies for hypercoagulation disorders all yielded negative results. After endoscopic extraction of bile duct stones and broad-spectrum antibiotic therapy, the patient recuperated with complete recanalization of the occluded portal vein. To our knowledge, pylephlebitis associated with acute infected choledocholithiasis has never been reported. This report details the clinical features, radiographic findings, pathogenesis, and treatment of this distinctly unusual manifestation. Early identification of pylephlebitis and underlying intra-abdominal infection can be achieved by exquisite imaging studies with raised awareness in the clinical setting. Eradication of infectious foci and judicious administration of antimicrobials are essential to reduce the catastrophic morbidity and mortality of pylephlebitis.

Abdominal Cavity - diagnostic imaging

Abdominal Cavity - microbiology

Aged

Anti-Bacterial Agents - administration & dosage

Bacteremia - complications

Bacteremia - diagnostic imaging

Bacteremia - therapy

Bacteroides fragilis

Bacteroides Infections - complications

Bacteroides Infections - diagnostic imaging

Bacteroides Infections - therapy

Cholangiopancreatography, Endoscopic Retrograde - methods

Choledocholithiasis - complications

Choledocholithiasis - diagnostic imaging

Choledocholithiasis - microbiology

Choledocholithiasis - therapy

Humans

Male

Portal Vein - diagnostic imaging

Portal Vein - microbiology

Remission Induction

Thrombophlebitis - complications

Thrombophlebitis - diagnostic imaging

Thrombophlebitis - microbiology

Thrombophlebitis - therapy

Tomography, X-Ray Computed - methods

Details

Title: Subtitle: Pylephlebitis associated with acute infected choledocholithiasis
Creators: Yu-Tzu Tsao - National Defense Medical Center
Shih-Hua Lin - National Defense Medical Center
Chih-Jen Cheng - National Defense Medical Center
Feng-Yee Chang - National Defense Medical Center
Resource Type: Journal article
Publication Details: The American journal of the medical sciences, Vol.332(2), pp.85-87
DOI: 10.1097/00000441-200608000-00006
PMID: 16909055
ISSN: 0002-9629
eISSN: 1538-2990
Language: English
Date published: 08/01/2006
Academic Unit: Nephrology; Internal Medicine
Record Identifier: 9984383893002771

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11 Times Cited - Web of Science