Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Demographic Characteristics
3.2. Types of Infection
3.3. Clinical Presentation
3.4. Thrombosis Site and Characteristics
3.5. Imaging Modalities
3.6. Treatment
3.7. Complications and Outcome
3.8. Pediatric Population
4. Discussion
4.1. Epidemiology
4.2. Microbiology
4.3. Clinical Presentation
4.4. Radiological Findings
4.5. Treatment
4.6. Complications and Outcome
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Demographic Characteristics | Number (%) | |
---|---|---|
Gender | ||
Male | 74 (71.8) | |
Female | 29 (28.2) | |
Pertinent Comorbidities | ||
Total | 29 (28.2) | |
Intra-abdominal surgery | 10 (9.7) | |
Pancreatitis | 8 (7.8) | |
Cirrhosis | 5 (4.9) | |
Thrombophilia | 4 (3.9) | |
IBD | 2 (1.9) | |
HCC | 1 (0.9) | |
Blood cultures | ||
Positive | 64 (62.1) | |
Negative | 21 (20.4) | |
Not reported | 18 (17.5) | |
Isolated pathogens | ||
E. coli | 21 (20.4) | |
Bacteroides spp. | 13 (12.6) | |
Streptococcus spp. | 12 (11.7) | |
Fusobacterium spp. | 10 (9.7) | |
Staphylococcus spp. | 6 (5.8) | |
Klebsiella spp. | 6 (5.8) | |
Clostridium spp. | 5 (4.8) | |
Enterococcus spp. | 5 (4.8) | |
Candida spp. | 2 (1.9) | |
Proteus mirabilis | 2 (1.9) | |
Actinomyces spp.; Micromonas micros; Eggerthella lenta; Gemella sanguinis; Morganella morganii | 1 (0.9) | |
Sites of infection | ||
Diverticulitis | 29 (28.2) | |
Appendicitis | 20 (19.4) | |
Hepatic abscess | 8 (7.8) | |
Pancreatitis | 6 (5.8) | |
Cholangitis | 6 (5.8) | |
Cholecystitis; colitis; foreign object ingestion; intra-abdominal surgery | 4(3.9) | |
Odontogenic bacteria | 3 (2.9) | |
Perisplenic abscess | 2 (1.9) | |
Retroperitoneal abscess; jejunitis; bowel ischemia | 1 (0.9) | |
Signs and symptoms | ||
Fever | 89 (86.4) | |
Abdominal pain | 81 (78.6) | |
Sepsis/septic shock | 60 (58.3) | |
Diarrhea | 27 (26.2) | |
Vomiting | 24 (23.3) | |
Jaundice | 21 (20.4) | |
Anorexia | 19 (18.4) | |
Nausea | 15 (14.6) | |
Hepatomegaly | 10 (9.7) | |
Ascites | 8 (7.8) | |
Splenomegaly | 7 (6.8) | |
GI bleeding | 5 (4.9) | |
Laboratory findings | ||
High CRP | 40/44 (90.9) | |
Leukocytosis | 78/87 (89.7) | |
High ESR | 12/14 (85.7) | |
Hyperbilirubinemia | 44/59 (74.6) | |
Increased AST, ALT | 53/74 (71.6) | |
Hypoalbuminemia | 11/16 (68.8) | |
Thrombocytopenia | 19/30 (63.3) | |
Anemia | 25/42 (59.5) | |
Treatments | Duration *** | |
Antimicrobials | 97 (94.2) | 25.9 (1–120) |
Anticoagulation | 79 (76.7) | 128.7 (1–365) |
Heparin | 29 (28.2) | |
Warfarin | 24 (23.3) | |
LMWH | 24 (23.3) | |
Xa inhibitors | 12 11.7) | |
Antithrombin III | 6 (5.8) | |
Other **** | 5 (4.9) | |
Acenocoumarol | 3 (2.9) | |
Outcome | ||
Alive | 89 (86.4) | |
Dead | 9 (8.7) | |
Unknown | 5 (4.9) |
Imaging | Number (%) |
---|---|
CT | 92 (89.3) |
US | 40 (38.8) |
MRI | 19 (18.4) |
Site of thrombosis | |
Main PV | 59 (57.3) |
SMV | 40 (38.8) |
Right branch PV | 30 (29.1) |
Left branch PV | 25 (24.3) |
Splenic vein | 13 (12.6) |
IMV | 10 (9.7) |
Umbilical veins | 1 (0.9) |
Occlusive thrombosis | |
Yes | 26 (25.2) |
No | 16 (15.6) |
Not reported | 61 (59.2) |
Thrombosis resolution | |
Yes | 25 (24.3) |
No | 17 (16.5) |
Partial | 5 (4.9) |
Unknown | 56 (54.3) |
Variables | Alive n (%) or Mean ± SD | Died n (%) or Mean ± SD | Univariate p-Value | Multivariate OR | Multivariate p-Value |
---|---|---|---|---|---|
Gender Female Male Age, years Pertinent comorbidities No Yes Diverticulitis as a cause No Yes Appendicitis as a cause No Yes Isolated bacteria No Yes Number of bacteria isolated Mono- or polymicrobial infection Monomicrobial Polymicrobial Sepsis No Yes Number of thrombosis sites Occlusive thrombosis No Yes Anticoagulation No Yes | 26 (29.2) 63 (70.8) 49.14 ± 19.57 68 (76.4) 21 (23.6) 63 (70.8) 26 (29.5) 71 (79.8) 18 (20.2) 17 (23.3) 56 (76.7) 1.48 ± 0.68 35 (62.5) 21 (37.5) 13 (20.6) 50 (79.4) 1.77 ± 0.95 14 (36.8) 24 (63.2) 8 (10.3) 70 (89.7) | 3 (33.3) 6 (66.7) 42.39 ± 28.62 3 (33.3) 6 (66.7) 7 (77.8) 2 (22.2) 9 (100.0) 0 (0.0) 3 (37.5) 5 (62.5) 2.40 ± 1.14 1 (20.1) 4 (80.0) 1 (11.1) 8 (88.9) 1.44 ± 0.72 1 (50.0) 1 (50.0) 1 (14.3) 6 (85.7) | 0.796 * 0.348 ** 0.006 * 0.658 * 0.135 * 0.376 * 0.009 ** 0.064 * 0.042 * 0.314 ** 0.708 * 0.740 * | 2.428 0.967 5.500 1.598 0.000 2.215 13.784 0.403 17.182 0.512 0.321 1.080 | 0.258 0.234 0.021 0.748 0.998 0.022 0.085 0.727 0.049 0.533 0.447 0.948 |
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Jevtic, D.; Gavrancic, T.; Pantic, I.; Nordin, T.; Nordstrom, C.W.; Antic, M.; Pantic, N.; Kaljevic, M.; Joksimovic, B.; Jovanovic, M.; et al. Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature. J. Clin. Med. 2022, 11, 4992. https://doi.org/10.3390/jcm11174992
Jevtic D, Gavrancic T, Pantic I, Nordin T, Nordstrom CW, Antic M, Pantic N, Kaljevic M, Joksimovic B, Jovanovic M, et al. Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature. Journal of Clinical Medicine. 2022; 11(17):4992. https://doi.org/10.3390/jcm11174992
Chicago/Turabian StyleJevtic, Dorde, Tatjana Gavrancic, Ivana Pantic, Terri Nordin, Charles W. Nordstrom, Marina Antic, Nikola Pantic, Marija Kaljevic, Bojan Joksimovic, Milan Jovanovic, and et al. 2022. "Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature" Journal of Clinical Medicine 11, no. 17: 4992. https://doi.org/10.3390/jcm11174992
APA StyleJevtic, D., Gavrancic, T., Pantic, I., Nordin, T., Nordstrom, C. W., Antic, M., Pantic, N., Kaljevic, M., Joksimovic, B., Jovanovic, M., Petcu, E., Jecmenica, M., Milovanovic, T., Sprecher, L., & Dumic, I. (2022). Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature. Journal of Clinical Medicine, 11(17), 4992. https://doi.org/10.3390/jcm11174992