Pylephlebitis - Purulent inflammation, accompanied by thrombosis of the portal vein and its branches. The clinical picture is nonspecific: fever with chills, abdominal pain, anorexia, jaundice and ascites are possible. The gold standard of diagnosis is a CT scan of the abdominal cavity; to confirm the diagnosis is carried out general and biochemical blood tests, ultrasound and Doppler blood vessels of the liver, MRI, plain radiography of the abdominal organs. Treatment is usually conservative, the main role belongs to the antibiotic and anticoagulant therapy, infusion and also spend symptomatic therapy. Surgical treatment is indicated only for the elimination of the infection (appendicitis).
acute appendicitis, often leads to the formation of abscesses in the liver and death. Prior to the era of computed tomography in the diagnosis of Gastroenterology was established only posthumously, but today, CT is the gold standard because it allows you to visualize the thrombotic mass in the portal vein in vivo. In connection with the detection of a rare pileflebita official statistics do not exist, but the differences in age and sex were found among the registered patients. An interesting fact is that the portal vein thrombosis almost never occurs in patients with viral hepatitis, although positive serological markers can not exclude the diagnosis pileflebita.
cirrhosis, increased blood clotting, tumor, invasive vascular intervention and certain other conditions.
Development pileflebita often contribute appendicitis, cholangitis, diverticulitis. Less common background for its occurrence are the penetration of ulcers of the stomach and duodenum, dysentery, abscesses in adrectal tissue, inflammation of hemorrhoids, phlebitis at the gynecological pathology, suprarenal abscesses, abscesses in the spleen and the mesenteric lymph nodes, pancreatitis and cholecystitis, ulcerative colitis. Separately considered pylephlebitis infants developing during infection of the umbilical residue (omphalitis).
In the presence of the infection in the abdomen or pelvis bacteria gradually penetrate into the bloodstream in the vessels formed microthrombuses. With bloodstream microorganisms are carried on venous abdominal pathological process gradually gets to the portal vein and its branches located in hepatic tissue thickness.
Inflammation in the portal vein leads to thickening and ulceration of its walls, purulent imbibition endothelium. For some time formed parietal or completely fill the lumen thrombotic mass. Gradually clots biodegradable and also soaked with pus. If inflamed gate Vienna opened during the operation, the walls of her dull and muddy, and the lumen of the pus.
Progression pileflebita often leads to the spread of infection to other organs, the formation of abscesses in the liver, the lungs, the brain, the development of sepsis. Perhaps the formation of intestinal abscess. The most common crops flora of ulcers identify E. coli and Proteus, Bacteroides, Streptococcus, Klebsiella. Much less is planted fungal flora.
diarrhea. Pylephlebitis sometimes leads to the development of portal hypertension, manifested bleeding from the stomach and intestines, vomiting red blood, melena, ascites. The formation of abscesses in the liver leads to the development of jaundice.
gastroenterologist and surgeon. Laboratory tests show signs of generalized inflammation (leukocytosis with a shift to the left), and liver function tests - elevated bilirubin levels, increased activity of alkaline phosphatase and GGT. Almost 90% of patients with blood culture pileflebitom (bacteriological blood culture) positive.
None of the laboratory and clinical signs pileflebita prevents with certainty establish the correct diagnosis. Sensitive enough to verify pileflebita possess only such research methods as ultrasound, Doppler blood vessels of the liver, MRI, CT scan of the abdomen and hepatic veins. The advantage of CT is the ability to identify the primary site of infection. Panoramic radiography is performed only for the differential diagnosis indicated.
Differentiate pylephlebitis followed with portal vein thrombosis without inflammation, liver abscesses, Budd-Chiari syndrome (fulminant course), cholecystitis, cholangitis, thrombosis of the mesenteric arteries and veins retroperitoneal, sepsis, schistosomiasis, typhoid.
heparin, thereafter a transition to oral forms of drugs. Under indications symptomatic and detoxication therapy, parenteral nutrition.
Surgical intervention is necessary to eliminate the primary site of infection (appendectomy, cholecystectomy). Previously, patients with appendicitis were offered a technique of surgery, during which produces a.ileocolica ligation when the first symptoms pileflebita, but the operation has not been practical application.
Prediction and prevention pileflebita
Forecast at pylephlebitis alert, although with the introduction of the practice of CT and MRI mortality rate was reduced from 90% to 40%. Pileflebita Prevention is a timely treatment of inflammatory diseases of the abdominal cavity and small pelvis, accurate execution of operations and invasive vascular studies. It is known that after an appendectomy takes pylephlebitis fulminant course, often leads to death. That is why the surgery for the removal of the altered gangrenous appendix should carefully inspect its vessels of the mesentery to quickly identify mesenteric vein thrombosis, and the spread of infection in the portal vein.