| Summary: | 碩士 === 國立臺灣大學 === 臨床醫學研究所 === 102 === Pylephlebitis is a septic thrombophlebitis of the portal venous system caused either by ascending infection from draining tissues of the portal venous system or by contagious infection from nearby organs. It is a rare complication of intra-abdominal infection; yet, the true incidence is difficult to evaluate. The mortality of pylephlebitis is high. Diverticulitis and appendicitis were major causes of pylephlebitis in the Western literature. However, in one-third of patients, the cause of pylephlebitis still remains obscured.
According to literature review, pylephlebitis primarily occurs in middle-aged males. About 80 % of patients have an initial presentation of abdominal pain and fever, but the symptoms and signs may be nonspecific, resulting in delayed diagnosis. Positive blood cultures have been reported in 23–88 % of cases, most commonly Gram- negative aerobes and anaerobes, for which empirical broad-spectrum antibiotics are recommended. The rate of spontaneous recanalization after acute portal thrombosis, though not well established, seems extremely low (ranging from 0 to 16.7 %). So far, the efficacy of anticoagulants for this indication remains controversial.
We retrospectively studied the etiology, clinical manifestation, and outcome by reviewing the medical records of all imaging-confirmed pylephlebitis cases diagnosed during the period 2002–2011 in the Emergency Department of National Taiwan university hospital. In this study, we aimed to conduct a retrospective clinical study on the recent trend of etiology, clinical manifestation, and prognosis of pylephlebitis, to see if it has distinct behavior in Taiwan from the Western country.
Like prior literature review, our results reveal that, male patients and those who are delayed in diagnosing intra-abdominal infection are more likely to have pylephlebitis.
Unlike prior literature review, in our study, the major cause of pylephlebitis is not gastrointestinal infection but liver abscess, especially liver abscess causes by Klebsiella pneumoniae infection. Mono- microbial K. pneumoniae was the most common pathogen of pylephlebitis in the present study, which might be related to a well-established unique endemic K. pneumoniae infection in Taiwan. Therefore, we recommended that initial empiric antibiotic treatment for pylephlebitis should cover K. pneumoniae in this region.
Even though, there is no mortality case in our study. Patients with pylephlebitis are more likely to have longer hospital stays, more likely to be transferred to intensive care unit and more likely to complicate with in-hospital infection. Therefore, it might indicate that, even in the modern medical era, patients with pylephlebitis face more complicated clinical situations and outcomes.
Therefore, when facing patients with pylephlebitis in Taiwan, it is important to remember its distinct microbial data. Also, it is practical to inform the patient and his/her family about the less favorable outcome of pylephlebitis.
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