Chronic appendicitis complicated by appendicular abscess, pylephlebitis and liver abscess

Discussion:

This case nicely demonstrates two rare but possible complications of an intra-abdominal infection - in this case of chronic appendicitis - that spreads via the portal venous drainage way:

  1. pylephlebitis, i.e. septic thrombosis of the portal vein or its tributaries, and

  2. a liver abscess

Additionally, this patient had an appendicular abscess, which was probably simmering for quite some time.

In the pre-computed tomography age and especially pre-antibiotics age, the above-mentioned pathologies were common complications of appendicitis. In recent years, these complications have become rare due to the advanced use of image techniques, calculated antibiotics therapy and early surgical intervention.

Like in this case, the patients presenting with pylephlebitis and/or liver abscess often have a background of alcohol/drug use and/or a general reluctance to go to the doctor due to unstable social circumstances.

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