门静脉脓毒性血栓性静脉炎:一例合并结肠静脉瘘和憩室炎的肾盂炎。

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Larissa Befurt, Arash Ghadim Khani, Ernst-Joachim Malzfeldt, Alexander Tobisch, Asad Kutup
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引用次数: 0

摘要

背景:肾盂炎是一种脓毒性血栓形成于门静脉系统或肠系膜静脉系统,是腹腔内炎症过程的并发症。我们提出的情况下,一个43岁的男子感染性血栓形成的门静脉引流区和结肠静脉瘘合并乙状状憩室炎。病例报告:患者在家中晕倒后出现非特异性症状,如弥漫性腹痛。体格检查时,患者心动过速(140次/分钟),伴有寒战和发热,体温38.3℃。其余检查结果无显著差异。初步实验室调查对感染有重要意义。腹部及骨盆CT显示乙状结肠憩室炎伴隐蔽性穿孔,肠系膜上静脉形成结肠静脉瘘,肝门静脉支内积气,肠系膜上静脉肾盂炎。乙状结肠整体切除和粘附回肠节段切除,保持肠道的连续性。幽门炎采用抗生素和抗凝治疗。病人完全康复了。结论:门静脉炎是门静脉化脓性血栓性静脉炎的统称。这是一种罕见但潜在致命的腹腔感染并发症,可导致感染性休克、肠道缺血或肝脓肿。不特异性的症状使早期诊断变得困难。手术切除炎症过程、抗生素治疗和抗凝是治疗的基石。尽管由于文献中相互矛盾的结果,抗凝剂在肾盂炎中的无限制使用仍然是争议的主题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Septic Thrombophlebitis in the Portal Veins: A Case of Pylephlebitis Linked to Colo-Venous Fistula and Diverticulitis.

BACKGROUND Pylephlebitis is a septic thrombosis in the portal or mesenteric venous system that occurs as a complication of an intra-abdominal inflammatory process. We present the case of a 43-year-old man with a septic thrombosis of the portal drainage area and a colo-venous fistula complicating a sigmoid diverticulitis. CASE REPORT The patient presented after collapsing at home with unspecific symptoms such as diffuse abdominal pain. On physical examination, he was tachycardic (140 beats/minute), with chills and fever to a temperature of 38.3°C. The remaining examination findings were unremarkable. Initial laboratory investigations were significant for an infection. Computed tomography (CT) with contrast of the abdomen and pelvis showed a sigmoid diverticulitis with covered perforation, forming a colo-venous fistula to the superior mesenteric vein, with gas trapped in the hepatic portal branches and a pylephlebitis of the superior mesenteric vein. An en bloc resection of the sigmoid and segmental resection of adherent ileum were performed, preserving intestinal continuity. Pylephlebitis was treated conservatively with antibiotics and anticoagulation. The patient recovered completely. CONCLUSIONS Pylephlebitis is the term used for septic thrombophlebitis of the portal veins. It is a rare but potentially fatal complication of an intra-abdominal infection, which can lead to septic shock, intestinal ischemia, or liver abscesses. The unspecific symptoms make early diagnosis difficult. Surgical removal of the inflammatory process, antibiotic therapy, and anticoagulation form the cornerstones of therapy. Although the unrestricted use of anticoagulation in pylephlebitis continues to be the subject of controversy due to conflicting results in the literature.

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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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