Abstract
We report on a young man who developed complicated pylephlebitis after foodborne illness. Despite antibiotics and resection of the focus of infectious colitis, he developed extensive small bowel infarction. He was treated with anticoagulation, local thrombolytic infusion, and resection of irreversibly ischemic small bowel. Thrombophilia workup demonstrated heterozygosity for factor V Leiden and the prothrombin G20210A mutation. The complications of pylephlebitis can be minimized by using systemic anticoagulation, thrombectomy, and/or local thrombolytic infusion along with antibiotics and surgical management of the infection. Evaluation for thrombophilic states should be considered, particularly if a patient does not respond to initial therapy.
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
MeSH terms
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Adult
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Anti-Bacterial Agents / therapeutic use
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Anticoagulants / therapeutic use
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Colectomy
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Colitis / diagnosis
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Colitis / etiology*
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Colitis / therapy
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Colonoscopy
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DNA Mutational Analysis
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Factor V / genetics
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Foodborne Diseases / complications*
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Foodborne Diseases / diagnosis
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Foodborne Diseases / therapy
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Heterozygote
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Humans
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Ischemia / diagnosis
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Ischemia / etiology*
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Ischemia / therapy
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Male
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Mesenteric Ischemia
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Mutation
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Portal Vein*
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Prothrombin / genetics
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Thrombolytic Therapy
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Thrombophilia / complications*
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Thrombophilia / diagnosis
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Thrombophilia / genetics
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Thrombophilia / therapy
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Thrombophlebitis / diagnosis
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Thrombophlebitis / etiology*
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Thrombophlebitis / therapy
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Tomography, X-Ray Computed
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Treatment Outcome
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Vascular Diseases / diagnosis
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Vascular Diseases / etiology*
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Vascular Diseases / therapy
Substances
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Anti-Bacterial Agents
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Anticoagulants
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factor V Leiden
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Factor V
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Prothrombin
Supplementary concepts
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Thrombophilia, hereditary