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Pyogenic Liver Abscess
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Rajeev M. Joshi, Murtaza Dadla, Sandeep Sangale
Biliary obstruction results in bile stasis with the potential for subsequent bacterial colonization, infection, and ascending infection into the liver. Bilioenteric anastomoses (by virtue of causing ascending cholangitis), trauma, and biliary instrumentation (percutaneous or endoscopic) biliary procedures can lead to pyogenic liver abscesses. In Asia, intrahepatic biliary stones and cholangitis are common causes while in the West, malignant obstruction is the predominant cause. Any infectious disease of the gastrointestinal tract can result in liver abscess. The most common causes of pylephlebitis are diverticulitis, appendicitis, pancreatitis, inflammatory bowel disease, pelvic inflammatory disease, perforated viscus, and omphalitis in newborn. Systemic infections such as infective endocarditis, pneumonia, or osteomyelitis may also lead to bacteremia and seeding of infection into the liver via the hepatic artery. Direct extension includes suppurative cholecystitis, subphrenic abscess, perinephric abscess, and perforation of the bowel directly into the liver [1].
Diseases of the Hepatobiliary Tree and Pancreas Associated with Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Patients with cirrhosis have an increased tendency to infection, most frequently involving the respiratory, urinary, and gastrointestinal tracts. These cases do not usually present much difficulty in diagnosis. Septicemia or bacteremia may complicate intestinal infections, or peritoneal infections following various manipulative procedures, such as paracentesis, lap-aroscopy, and surgery. The patient may complain of fever, chills, abdominal pain, diarrhea, and expanding ascites. Blood culture will usually permit the isolation of the causative organism. Occasionally, the infection is confined to the portal system, resulting in pylephlebitis, which is characterized by unexplained fever and increasing signs of portal hypertension, especially gastrointestinal bleeding and ascites.
Medical and Surgical Treatment of Intra-abdominal Infections
Published in Thomas T. Yoshikawa, Shobita Rajagopalan, Antibiotic Therapy for Geriatric Patients, 2005
John G. Carson, Ryan W. Patterson, Samuel Eric Wilson
Complications include perforation, peritonitis, and appendiceal abscess. Perforation by the time of appendectomy occurs in nearly 50% of patients aged over 50 years resulting in generalized peritonitis to microabscesses (21). Appendiceal abscess develops when localized perforation and periappendiceal infection are walled off by the omentum, mesentery, and viscera. Patients present with clinical appendicitis and RLQ mass. An ultrasound and CT should be performed, and if an abscess is found, percutaneous image-guided drainage may be considered. Operation for appendectomy and abscess drainage may be done if the abscess is known with certainty to be caused by appendicitis. Pylephlebitis is suppurative thrombophlebitis of the portal venous system, which characteristically presents with fever, chills, low-grade jaundice, and eventually hepatic abscesses; however, this presentation is encountered rarely today. CT scan is the best method for detecting thrombosis and gas in portal venous system.
Pylephlebitis treated with apixaban
Published in Hospital Practice, 2019
Graham R Hale, Leon Alan Sakkal, Taki Galanis
Pylephlebitis is an infected thrombus of the portal vein or one of its tributaries [1,2]. In the past, pylephlebitis was a relatively well documented complication of intra-abdominal suppurative processes [3]. Today, pylephlebitis is a rare disease primarily discussed in case reports. The most common etiologies are diverticulitis, appendicitis, pancreatitis, and inflammatory bowel disease. Risk factors thought to be related to pylephlebitis include recent and remote abdominal procedures, immunosuppression, malignancy, and smoking [4,5]. Pylephlebitis is frequently complicated by hepatic abscesses and bacteremia [1]. The signs and symptoms of pylephlebitis are nonspecific, vary widely and can go unnoticed: fever, fatigue, abdominal pain (diffuse or focal, mild to severe), normal or slightly elevated liver function tests, and leukocytosis [1,4]. Untreated pylephlebitis can lead to intestinal ischemia, infarction, septic shock, and death [6]. The goals of treating pylephlebitis are to correct any underlying causes, prevent thrombus extension, and achieve recanalization. This case details a patient presenting with splenic vein pylephlebitis, multiple splenic infarcts, Parvimonas micra bacteremia, and a polymicrobial splenic abscess. We discuss Parvimonas micra infections found in the literature and the use of apixaban in the treatment of this rare disease.