title: Acute Appendicitis Complicating into Portal and Superior Mesenteric Vein Thrombosis.
abstract: This case report describes a young man who presented with 9-day history of sudden-onset epigastric and right-sided lower abdominal pain. He was tachycardiac with temperature of 102°F. Tenderness was present in the peri-umbilical area and right iliac fossa. Investigations revealed a raised total leucocyte count (predominantly neutrophilic). Triphasic CTscan abdomen found thrombosis of right portal vein and its hepatic tributaries alongwith superior mesenteric vein (SMV) and its tributaries. Co-existent fluid in right hemipelvis abutting the cecum and appendiceal tip was suggestive of acute appendicitis. He was resuscitated with fluids and analgesics and started on intravenous metronidazole and ceftriaxone. Anticoagulation with subcutaneous heparin was commenced and eventually switched over to warfarin. Appendicectomy was not performed as the patient responded to conservative treatment. Appendicitis is associated with multiple complications but secondary venous thrombosis has rarely been reported with it.
authors.affiliation: Department of Surgery, Ward A, Khyber Teaching Hospital, Peshawar.
authors.forename: Adnan
authors.initials: A
authors.lastname: Yousaf
authors.affiliation: Department of Surgery, Ward A, Khyber Teaching Hospital, Peshawar.
authors.forename: Mushtaq
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Department of Surgery, Ward A, Khyber Teaching Hospital, Peshawar.
authors.forename: Mahmud
authors.initials: M
authors.lastname: Aurangzeb
mesh_terms: D000208:Acute Disease; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000008:administration & dosage*; D001064:Appendicitis / Q000150:complications; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging*; D008795:Metronidazole / Q000627:therapeutic use*; D011169:Portal Vein / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000890:Anti-Infective Agents; D000925:Anticoagulants; D008795:Metronidazole; D014859:Warfarin