Pylephlebitis, which is a type of septic thrombophlebitis of the portal vein, is a rare and life-threatening complication that commonly occurs following appendicitis. However, nonspecific abdominal complaints and fever can impede the diagnosis of pylephlebitis. Timely use of appropriate antibiotics and anticoagulants is paramount for treating this condition. We present a case of pylephlebitis and septic shock caused by acute nonperforated appendicitis. A 32-year-old man presented with migratory right lower abdominal pain. Blood cultures showed the presence of Escherichia coli. Blood test results showed increased bilirubin concentrations and coagulation factor abnormalities. A computed tomographic abdominal scan showed that the portal vein had a widened intrinsic diameter. After intensive care treatment with antibiotics, antishock therapy, anticoagulants, and other supportive treatments, the infection was monitored, the abdominal pain disappeared, and the jaundice subsided. Laparoscopic appendectomy was performed. Histopathology showed acute suppurative appendicitis, and no abnormalities were observed during the follow-up period after discharge. A multidisciplinary approach is mandatory for the decision-making process in the presence of pylephlebitis caused by appendicitis to obtain a correct diagnosis and prompt treatment. Similarly, the timing of appendectomy is important for minimizing intra- and postoperative complications.

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.

Acute appendicitis (AA) patients who present with a significantly increased level of D-dimer is not common. We speculated that the increase of D-dimer level was a result of pylephlebitis complication in the appendicitis patient. A 34-year-old man presented to the emergency department with sudden onset of lower quadrant abdomen pain. He was diagnosed with AA and scheduled for a laparoscopic appendectomy. He had a blood pressure of 80-90/30-40 mmHg, heart rate of 120-130/min, and his temperature was 38.3 °C. Routine blood test demonstrated a significantly elevated D-dimer (14,037 µg/L) with a negative blood gas test, normal ultrasound of the lower limbs, and normal pulmonary and abdominal computer tomography angiography (CTA) scans. Further tests showed a two-fold increase in D-dimer and abnormal hepatic function, indicating pylephlebitis, a rare but serious complication of AA. The patient was subjected to laparoscopic appendectomy, removing the cause of pylephlebitis, and received intravenous broad-spectrum antibiotics for an additional 1 week. The patient had clinical improvement with almost complete normalization of his D-dimer, white blood cell (WBC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), fibrin degradation product (FDP) and platelet (PLT) levels. The patient was fully recovered and discharged from the hospital without any complications. Pylephlebitis secondary to AA is rare and can be easily missed. The unusual increase of D-dimer level provided critical value for pylephlebitis diagnosis.