PDF(Pubmed)
Abstract：
UNASSIGNED: Pylephlebitis refers to an infective suppurative thrombosis that occurs in the portal vein and its branches. Concurrent pylephlebitis and subarachnoid hemorrhage (SAH) are rare but fatal for patients with sepsis. This scenario drives the clinicians into a dilemma of how to deal with coagulation and bleeding simultaneously.
UNASSIGNED: An 86-year-old man was admitted to hospital for chills and fever. After admission, he developed headache and abdominal distension. Neck stiffness, Kernig\'s and Brudzinski\'s sign were present. Laboratory tests discovered decreased platelet count, elevated inflammatory parameters, aggravated transaminitis, and acute kidney injury. Escherichia coli (E. coli) were identified in blood culture. Computed tomography (CT) revealed thrombosis in the superior mesenteric vein and portal veins. Lumbar puncture and Brain CT indicated SAH. The patient had eaten cooked oysters prior to illness. It was speculated that the debris from oyster shell might have injured his intestinal mucosa and resulted in bacterial embolus and secondary thrombosis in portal veins. The patient was treated with effective antibiotics, fluid resuscitation, and anticoagulation. The dose titration of low molecular weight heparin (LMWH) under close monitoring attributed to diminution of the thrombosis and absorption of SAH. He recovered and was discharged after 33-day treatment. One-year follow-up indicated that the post-discharge course was uneventful.
UNASSIGNED: This report describes a case of an octogenarian with E. coli septicemia who survived from concurrent pylephlebitis and SAH along with multiple organ dysfunction syndrome. For such patients with life-threatening complications, even in the acute stage of SAH, decisive employment of LMWH is essential to resolve thrombosis and confers a favorable prognosis.
UNASSIGNED: An 86-year-old man was admitted to hospital for chills and fever. After admission, he developed headache and abdominal distension. Neck stiffness, Kernig\'s and Brudzinski\'s sign were present. Laboratory tests discovered decreased platelet count, elevated inflammatory parameters, aggravated transaminitis, and acute kidney injury. Escherichia coli (E. coli) were identified in blood culture. Computed tomography (CT) revealed thrombosis in the superior mesenteric vein and portal veins. Lumbar puncture and Brain CT indicated SAH. The patient had eaten cooked oysters prior to illness. It was speculated that the debris from oyster shell might have injured his intestinal mucosa and resulted in bacterial embolus and secondary thrombosis in portal veins. The patient was treated with effective antibiotics, fluid resuscitation, and anticoagulation. The dose titration of low molecular weight heparin (LMWH) under close monitoring attributed to diminution of the thrombosis and absorption of SAH. He recovered and was discharged after 33-day treatment. One-year follow-up indicated that the post-discharge course was uneventful.
UNASSIGNED: This report describes a case of an octogenarian with E. coli septicemia who survived from concurrent pylephlebitis and SAH along with multiple organ dysfunction syndrome. For such patients with life-threatening complications, even in the acute stage of SAH, decisive employment of LMWH is essential to resolve thrombosis and confers a favorable prognosis.
摘要：
■静脉炎是指发生在门静脉及其分支中的感染性化脓性血栓形成。并发静脉炎和蛛网膜下腔出血（SAH）很少见，但对败血症患者来说是致命的。这种情况使临床医生陷入如何同时处理凝血和出血的困境。
一名86岁男子因寒战和发烧入院。入院后,他出现了头痛和腹胀。颈部刚度,Kernig和Brudzinski的标志出现了。实验室检查发现血小板计数下降,炎症参数升高，严重的转氨酶，和急性肾损伤。大肠杆菌(E.大肠杆菌)在血液培养中鉴定。计算机断层扫描（CT）显示肠系膜上静脉和门静脉血栓形成。腰椎穿刺及脑CT提示SAH。病人在生病前吃过煮熟的牡蛎。据推测，牡蛎壳的碎片可能损伤了他的肠粘膜，并导致细菌栓塞和门静脉继发性血栓形成。病人接受了有效的抗生素治疗,液体复苏,和抗凝。密切监测下的低分子量肝素（LMWH）的剂量滴定归因于血栓形成和SAH吸收的减少。他康复并在33天治疗后出院。一年的随访表明，出院后课程进展顺利。
■本报告描述了一例患有大肠杆菌败血症的八十岁老人，他在并发的肾静脉炎和SAH以及多器官功能障碍综合征中幸存下来。对于这种有危及生命的并发症的患者，即使在SAH的急性期,决定性地使用LMWH对于解决血栓形成和预后良好至关重要.
一名86岁男子因寒战和发烧入院。入院后,他出现了头痛和腹胀。颈部刚度,Kernig和Brudzinski的标志出现了。实验室检查发现血小板计数下降,炎症参数升高，严重的转氨酶，和急性肾损伤。大肠杆菌(E.大肠杆菌)在血液培养中鉴定。计算机断层扫描（CT）显示肠系膜上静脉和门静脉血栓形成。腰椎穿刺及脑CT提示SAH。病人在生病前吃过煮熟的牡蛎。据推测，牡蛎壳的碎片可能损伤了他的肠粘膜，并导致细菌栓塞和门静脉继发性血栓形成。病人接受了有效的抗生素治疗,液体复苏,和抗凝。密切监测下的低分子量肝素（LMWH）的剂量滴定归因于血栓形成和SAH吸收的减少。他康复并在33天治疗后出院。一年的随访表明，出院后课程进展顺利。
■本报告描述了一例患有大肠杆菌败血症的八十岁老人，他在并发的肾静脉炎和SAH以及多器官功能障碍综合征中幸存下来。对于这种有危及生命的并发症的患者，即使在SAH的急性期,决定性地使用LMWH对于解决血栓形成和预后良好至关重要.
