World Journal of Medical and Surgical Case Reports Volume No 6

Case Report Open Access

A Rare Complication after Laparoscopic Appendectomy: Septic Thrombosis of Superior Mesenteric Vein

Erdal Uysal, Mehmet Alı Ikidag, Mehmet Dokur and Basar Aksoy
World Journal of Medical and Surgical Case Reports 2015, 4:3

Abstract

Introduction

Septic pylephlebitis and thrombosis of superior mesenteric vein is a rare but life threatening complication of acute appendicitis. The aim of this presentation is to share our experience in diagnosis and management of a patient with septic thrombosis of superior mesenteric vein (SMV) encountered after laparoscopic appendectomy and to call attention to this rare but fatal entity.

Case Presentation

A 28 years old male presented to the emergency room with complaints of fever and severe abdominal pain. He had a history of laparoscopic appendectomy 1 week ago in another hospital. His body temperature was 39.5degree C, White Blood Cell was 10.7 103/mm3, C Reactive Protein was 118 mg/dl. The patient underwent contrast enhanced computed abdominal tomography examination for etiological work up. There were endoluminal trombus and increase in the diamater of superior mesenteric vein in its 8 centimeters segment. The patient was hospitalised, parenteral systemic antibiotherapy was started with third generation cephalosporin and metranidazole. Also antiocoagulant medication was started, with subcutaneous low molecular weighted heparin, 1mg/kg, twice a day. Control computed abdominal tomography performed 1 week later showed partial decline in the size of trombus and diamater of superior mesenteric vein. Heparine was switched to warfarine, and the patient was discharged. In his third week control, he was symptom free and laboratory findings were in normal ranges.

Conclusion

Septic pylephlebitis and thrombosis of superior mesenteric vein is a rare but life threatening complication of acute appendicitis. Parenteral anticoagulants and antibiotics are the first choice in the treatment and should be started immediately, interventional radiology or surgical treatment may be used in selected cases. Contrast enhanced computed abdominal tomography is the first choice among radiological modalities in diagnosis.

Key words

appendectomy, septic thrombosis, superior mesenteric vein




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