Purpose or Case Report: To present a series of patients with pylephlebitis without a significant past medical history
Methods & Materials: Clinical charts of previously healthy children diagnosed with pylephlebitis between January 2012 and April 2013 were reviewed.
Results: During the study period six patients without a significant past medical history presented pylephlebitis. Three of them were newborns without a history of umbilical catheterization, from which two presented omphalitis and one presented peritonitis. From the remaining patients, which were 9 to 14 years old, two had acute appendicitis and one had diarrhea. Blood cultures were positive in four out of the 6 patients evaluated (Staphylococcus aureus, 3; Streptococcus pyogenes, 1). Disease was considered severe in four of the patients (3 newborns and 1 child) requiring inotropic support and mechanical ventilation. One of them died. Diagnosis was made using ultrasonography in all cases.Additionally liver abscesses were shown in 5 cases, thrombosis of the tributaries of the portal venous system in 5 cases, and ascites in3 cases. Computed tomography scan was performed in two patients, confirming the ultrasonography findings. All patients received antibiotics and anticoagulant therapy and one newborn received fibrinolytic agents as well. Three cases required fluid collection drainage. Three patients presented a portal cavernoma from which two did not recovered portal venous flow on ultrasonography performed after 3 weeks of follow-up.
Conclusions: Pylephlebitis is an infectious portal vein thrombosis, usually associated with omphalitis, intra-abdominal infections, or abdominal surgery. Symptoms are nonspecific. Ultrasonography is a sensitive, noninvasive tool for the diagnosis allowing early detection and disease control. In the majority of cases, further imaging studies are not required