Abstract
Acute portal vein thrombosis is a rare but severe complication of intra-abdominal infection. It can be life-threatening, given the risk of developing liver abscess and subsequent liver failure. Various types of hereditary thrombophilia are known risk factors for acute portal vein thrombosis. In addition to surgical treatment and potent antibiotic therapy, systemic administration of anticoagulants and locoregional trans-catheter delivery of thrombolytic agents are known to be effective. We present a case report of acute portal vein thrombosis with pylephlebitis caused by acute appendicitis, successfully treated with catheter-directed thrombolysis through the operatively recanalized umbilical vein. The umbilical vein is a promising access route to the portal vein. Therefore, this procedure is an effective and preferred treatment option for portal septic thrombosis, particularly because it does not require puncture of the liver parenchyma or catheterization through an infected peritoneal cavity.
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Bogue CO, Leahy TR, Rea DJ, Bitnun A, Bradao LR, Kahr WHA. Idiopathic suppurative pylephlebitis: interventional radiological diagnosis and management. Cardiovasc Intervent Radiol. 2009;32:1304–7.
Parikh S, Shah R, Kapoor P. Portal vein thrombosis. Am J Med. 2010;123:111–9.
Choi BK, Yang SH, Suh K, Hwang JA, Lee MH, Si WK, et al. A case of portal vein thrombosis by protein C and S deficiency completely recanalized by anticoagulation therapy. Chonnam Med J. 2011;47:185–8.
Castro R, Fernandes T, Oliveira MI, Castro M. Acute appendicitis complicated by pylephlebitis: a case report. Case Rep Radiol. 2013;2013:627521.
Levin C, Koren A, Miron D, Lumelsky D, Nussinson E, Siplovich L, et al. Pylephlebitis due to perforated appendicitis in a teenager. Eur J Pediatr. 2009;168:633–5.
Henao EA, Bohannon WT, Silva MB. Treatment of portal venous thrombosis with selective superior mesenteric artery infusion of recombinant tissue plasminogen activator. J Vasc Surg. 2003;38:1411–5.
Ozdogan M, Gurer A, Gokakin AK, Kulagoglu H, Aydin A. Thrombolysis via an operatively placed mesenteric catheter for portal vein and superior mesenteric vein thrombosis: report of a case. Surg Today. 2006;36:846–8.
Kaplan JL, Weintraub SL, Hunt JP, Gonzalez A, Leopa J, Brazzini A. Treatment of superior mesenteric and portal vein thrombosis with direct thrombolytic infusion via an operatively placed mesenteric catheter. Am Surg. 2004;70:600–4.
Wang MQ, Lin HY, Guo LP, Liu FY, Duan F, Wang ZJ. Acute extensive portal and mesenteric venous thrombosis after splenectomy: treated by interventional thrombolysis with transjugular approach. World J Gastroenterol. 2009;15:3038–45.
Hollingshead M, Burke CT, Mauro MA, Weeks SM, Dixon RG, Jaques PF. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol. 2005;16:651–61.
Shinkai M, Ohhama Y, Honda S, Kitagawa N, Mochizuki K, Take H, et al. Recanalized umbilical vein as a conduit for mesenterico/porto-Rex bypass for patients with extrahepatic portal vein obstruction. Pediatr Surg Int. 2011;27:315–9.
Facciuto ME, Rodriguez MI, Singh MK, Rocca JP, Rochon C, Chen W. Recanalized umbilical vein conduit for meso-Rex bypass in extrahepatic portal vein obstruction. Surgery. 2009;145:406–10.
Pollad C, Gravante G, Webb M, Chung W, Illouz S, Ong S, et al. Use of the recanalised umbilical vein for islet autotransplantation following total pancreatectomy. Pancreatology. 2011;11:233–9.
Soyama A, Eguchi S, Takatsuki M, Hidaka M, Muraoka I, Tomonaga T, et al. Tumor thrombectomy via a surgically reopened umbilical vein combined with right hemihepatectomy in a patient with hepatocellular carcinoma. Dig Surg. 2011;28:222–5.
Rochon C, Sheiner PA, Sharma J, Rodriguez MI, Savino J, Facciuto M. The utility of recanalized umbilical vein graft to the hepato-pancreato-biliary surgeon. Surg Innov. 2013;20:126–33.
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Conflict of Interest: Ichiro Tamaki, Kazuhiro Kami, Eiji Yamamoto, and Taisuke Morimoto declare that they have no conflict of interest.
Human/Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).
Informed Consent: Informed consent was obtained from all patients for being included in the study.
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Tamaki, I., Kami, K., Yamamoto, E. et al. Catheter-directed thrombolysis through the operatively recanalized umbilical vein for acute extensive portal vein thrombosis: report of a case. Clin J Gastroenterol 7, 376–380 (2014). https://doi.org/10.1007/s12328-014-0510-6
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DOI: https://doi.org/10.1007/s12328-014-0510-6