title: Pylephlebitis and acute mesenteric ischemia in a young man with inherited thrombophilia and suspected foodborne illness.
abstract: We report on a young man who developed complicated pylephlebitis after foodborne illness. Despite antibiotics and resection of the focus of infectious colitis, he developed extensive small bowel infarction. He was treated with anticoagulation, local thrombolytic infusion, and resection of irreversibly ischemic small bowel. Thrombophilia workup demonstrated heterozygosity for factor V Leiden and the prothrombin G20210A mutation. The complications of pylephlebitis can be minimized by using systemic anticoagulation, thrombectomy, and/or local thrombolytic infusion along with antibiotics and surgical management of the infection. Evaluation for thrombophilic states should be considered, particularly if a patient does not respond to initial therapy.
authors.affiliation: Division of Vascular Surgery, Washington Hospital Center, Washington, DC 20010, USA. sarah.p.pradka@medstar.net
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Pradka
authors.forename: Christine T
authors.initials: CT
authors.lastname: Trankiem
authors.forename: John J
authors.initials: JJ
authors.lastname: Ricotta
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D003082:Colectomy; D003092:Colitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003113:Colonoscopy; D004252:DNA Mutational Analysis; D005165:Factor V / Q000235:genetics; D005517:Foodborne Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006579:Heterozygote; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D065666:Mesenteric Ischemia; D009154:Mutation; D011169:Portal Vein; D011516:Prothrombin / Q000235:genetics; D015912:Thrombolytic Therapy; D019851:Thrombophilia / Q000150:complications* / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D013924:Thrombophlebitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin