Portal Vein Thrombosis Resulted from Delay Diagnosis of Ruptured Appendicitis

Shu-Cheng Kuo, Yi-Chun Chen, Chun-Chieh Chao
2019 Surgical Research  
Portal vein thrombosis may result from different etiologies, and the clinical presentation is changeable. Septic thrombo-phlebitis of portal vein may be resulted from intra-abdominal inflammatory process such as appendicitis. Portal venous thrombosis accounts for a mortality rate of 5 -20%. Early diagnosis, rapid usage of antibiotics and early anti-coagulation could decrease the complication. Case presentation: We report a case of 63-year-old female who experienced fever and abdominal pain in
more » ... ght lower quadrant. She was referred to our emergency department with signs of septic shock and jaundice. Tenderness was complained in the peri-umbilical area and right iliac fossa. Icteric sclera was also noted in in emergency department. Laboratory examination revealed a raised total leukocyte count (predominantly neutrophilic). Noncontrasted CT scan abdomen found swelling of appendix with peri-focal fatty stranding. Conservative treatment was arranged due to the suspicion of sepsis from cholangitis instead of appendicitis. Appendectomy was done 2 days after diagnosis and pathology proves the diagnosis of ruptured appendicitis. However, progressive elevation in bilirubin was noted for 2 days after operation. Abdomen CT with contrast was arranged and showed portal vein thrombosis. Intravenous anti-coagulation was prescribed and patient was discharged eventually. Conclusion: Symptoms of portal vein thrombosis may be diverse and atypical, so the diagnosis is often delayed. Highly clinical suspicion should keep in mind for patient with risk. This report described a rare complication of portal vein thrombosis in acute appendicitis. Once identified, broad-spectrum of antibiotics and anti-coagulation should be prescribed.
doi:10.33425/2689-1093.1018 fatcat:z2l7flsamjh5bofseweoypzcjm