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      Complicated Pylephlebitis Secondary to Perforated Appendicitis in an Adolescent

      case-report

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          Abstract

          Septic thrombophlebitis of the portal vein or pylephlebitis is a rare cause of morbidity and mortality in children. The common causes include infective intra-abdominal pathology (acute appendicitis or diverticulitis) or inflammatory conditions (acute pancreatitis and inflammatory bowel disease). Management involves a multidisciplinary team approach for favorable outcome. We present a case report of pylephlebitis secondary to perforated appendicitis with incomplete resolution of thrombosis.

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          Pylephlebitis: a Review of 95 Cases.

          Donald Jenkins, Martin D Zielinski, Asad Choudhry … (2016)
          Pylephlebitis, or suppurative thrombophlebitis of the portal mesenteric venous system occurring in the setting of abdominal inflammatory processes, is a rare but deadly disease commonly associated with diverticulitis. We review our institutional experience in the management of patients with this condition. A retrospective review of medical records from 2002 to 2012 was performed. Patients with a portal mesenteric vein thrombosis (PMVT) within 30 days of an intra-abdominal inflammatory process were identified and evaluated. Ninety-five patients were included. The mean patient age at presentation was 57 years (range, 24-88). The most common associated processes were pancreatitis (31 %), followed by diverticulitis (19 %). Bacteremia was noted in 34 (44 %) patients. The most common organism cultured was Streptococcus viridans. Antibiotic and anticoagulation therapy was given in 86 (91 %) and 78 (82 %) patients, respectively. Overall, we report an 11 % mortality rate. Albeit rare, pylephlebitis most commonly was manifested in the setting of pancreatitis. Treatment should be individualized to culture results and extent of thrombosis. If diagnosed early and managed appropriately, a favorable outcome is possible.
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            Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis

            Virginia Hernandez-Gea, Andrea De Gottardi, Frank Leebeek … (2019)
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              Pylephlebitis due to perforated appendicitis in a teenager.

              Dan Miron, Yoseph Horovitz, Ariel Koren … (2009)
              Pylephlebitis, a septic thrombophlebitis of the portal vein, is a life-threatening complication of intraabdominal infections, commonly associated with acute appendicitis in children, and diverticulitis in adults. A 13-year-old boy was admitted for high fever and jaundice. On the fifth day of hospitalization, ultrasound Doppler flow and Computer Tomography scan studies showed thrombosis of the portal vein and acute appendicitis. The patient was treated with antibiotics, anticoagulation and laparotomy with appendectomy. No thrombophilic risk factors were diagnosed. Our aim is to improve physicians' awareness of this complication and emphasize the importance of early diagnosis and appropriate therapy in children in order to reduce serious complications and long-term sequels.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Indian Assoc Pediatr Surg
                Journal ID (iso-abbrev): J Indian Assoc Pediatr Surg
                Journal ID (publisher-id): JIAPS
                Title: Journal of Indian Association of Pediatric Surgeons
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0971-9261
                ISSN (Electronic): 1998-3891
                Publication date (Print): Jan-Feb 2022
                Publication date (Electronic): 11 January 2022
                Volume: 27
                Issue: 1
                Pages: 115-117
                Affiliations
                [1]Department of Pediatric Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi, India
                [1 ]Department of Pediatrics, Apollo Hospital, Noida, Uttar Pradesh, India
                Author notes
                Address for correspondence: Dr. Sagar Jayesh Mehta, A 1304/Orchid Suburbia, New Link Road, Kandivali West, Mumbai - 400 067, Maharashtra, India. E-mail: drsagarmehta88@ 123456gmail.com
                Article
                Publisher ID: JIAPS-27-115
                DOI: 10.4103/jiaps.JIAPS_291_20
                PMC ID: 8853607
                PubMed ID: 35261528
                SO-VID: d4e56a10-a5f4-448b-8867-88b0d3f07ddc
                Copyright © Copyright: © 2022 Journal of Indian Association of Pediatric Surgeons
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 20 August 2020
                Date revision received : 22 November 2020
                Date accepted : 09 January 2021
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: acute abdomen,anticoagulation,appendicitis,pylephlebitis
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: acute abdomen, anticoagulation, appendicitis, pylephlebitis

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