Interval laparoscopic appendectomy for appendicitis complicated by pylephlebitis.
BACKGROUND
Although rare, portal mesenteric venous thrombosis and pylephlebitis remain potential life-threatening sequelae of ruptured appendicitis in children. Treatment recommendations from recent reports have included urgent exploratory laparotomy with appendectomy, prolonged intravenous antibiotic therapy, and anticoagulation for up to a year.


METHODS
This report describes successful management of pylephlebitis and mesenteric venous thrombosis complicating ruptured appendicitis with intravenous antibiotics and anticoagulation followed by interval laparoscopic appendectomy.


RESULTS
A previously healthy 5-year-old girl was diagnosed with ruptured appendicitis complicated by pylephlebitis and mesenteric venous thrombosis at the time of presentation. She was treated with intravenous antibiotics and anticoagulated for 3 months. She subsequently underwent interval laparoscopic appendectomy. At 3-year follow-up, she is healthy without evidence of adverse sequelae.


CONCLUSIONS
This is the first reported case of successful, minimally invasive management of ruptured appendicitis complicated by mesenteric venous thrombosis and pylephlebitis.


CONCLUSIONS
Similar treatment of other children with this rare presentation seems reasonable.
Stitzenberg
Karyn B
KB
Cecil G. Sheps Center for Health Services Research and Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
Piehl
Mark D
MD
Monahan
Paul E
PE
Phillips
J Duncan
JD
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008641:Mesenteric Vascular Occlusion / Q000150:complications / Q000188:drug therapy; D008642:Mesenteric Veins; D011169:Portal Vein; D013924:Thrombophlebitis / Q000150:complications* / Q000188:drug therapy; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D000925:Anticoagulants