[Pylephlebitis: a rare but possible complication of intra-abdominal infections]. / Pileflebitis: una extraña pero posible complicación de las infecciones intraabdominales.

BACKGROUND: Pylephlebitis or septic thrombophlebitis of the portal venous system is a rare but serious complication of intra-abdominal infections which drain into the portal venous system. Its diagnosis is based on clinical suspicion and imaging tests, mainly a computed tomography scan, given the lack of specificity of the signs and symptoms. Spread of septic emboli is the major cause of morbidity and mortality. The aim of the study was to analyse patients diagnosed in our hospital. MATERIAL AND METHODS: Retrospective descriptive study of patients diagnosed with pylephlebitis in our hospital. CLINICAL CASES: Four patients were included, 3 men and one woman. In 3 cases it was acute cholecystitis that led to the diagnosis of pylephlebitis at the same time as the intra-abdominal infection. Emergency surgery was performed in one case, whilst the other 2 were treated conservatively. Blood cultures were performed in all cases, and empirical antibiotic treatment was used. In the only case of acute appendicitis, diagnosis of pylephlebitis was achieved during the study of postoperative fever, with empirical antibiotic treatment also being started. The haematologist was requested to start the required anticoagulation therapy in all cases. CONCLUSIONS: Pylephlebitis is a rare complication of intra-abdominal infections that may make lead to a worse outcome. A high level of suspicion is required as well as imaging tests to make an early diagnosis and appropriate treatment.

Bacterial translocation during liver transplantation: a randomized trial comparing conventional with venovenous bypass vs. piggyback methods.

The aim of this study was to evaluate the bacterial translocation in liver transplantation (LT), comparing the conventional and the piggyback methods. A total of 32 patients were randomized into the 2 groups. Samples of blood were collected from the radial artery, portal vein (PV) and hepatic vein (HV), in up to 120 minutes postreperfusion. The samples were sent for endotoxin level, as well as samples up to 2 minutes post-perfusion were sent to culture. Hepatic artery and PV blood flows were measured at postreperfusion collection times. The results analyzed were: endotoxin concentration, its quantity, and hepatic clearance. The statistical treatment consisted of analyzing each group's mean profile. The analysis for endotoxin concentration in the radial artery was the deviation related to presurgery measure, and in the PV the deviation related to preclamping (PC) measure. The overall mean level of endotoxin concentration was 0.99 EU/mL in the artery, 1.30 EU/mL in the PV, and 1.22 EU/mL in the HV. The deviation was significant in the portal (P = 0.0031), but not in the artery samples (P = 0.2092). We detected a significant quantity of endotoxin in the artery and in the portal and the HVs (P < 0.001). There was no difference between the 2 groups and no hepatic clearance of endotoxin was detected either (P = 0.1515). All the cultures were negative. In conclusion, the study detected a significant translocation of endotoxin, but not of bacteria. The study also detected the absence of endotoxin hepatic clearance in both the piggyback and the conventional methods without any difference between them.

A veia porta como via de disseminaçäo bacteriana: estudo experimental em cäes / Portal vein as dissemination way: experimental study in dogs

Com o objetivo de pesquisar em caes a presença de bactérias no sangue portal e seu papel como via de disseminaçao, realizou-se a investigaçao bacteriana do sangue da veia porta, da veia hepática esquerda, da bile da vesícula biliar e do tecido hepático. Foram empregados dezesseis caes (Canis familiaris), em jejum e com peso médio de 12,18 Kg. Todos os animais foram submetidos à laparotomia e as amostras de sangue, bile e tecido hepático colocados em meios líquidos com caldo de tripticaseína de soja, sendo depois semeados em placas de Petri, contendo meios enriquecidos e seletivos, a cada 48 horas, durante um período de 15 dias para bactérias aeróbias e 30 dias para bactérias anaeróbias. Nas culturas, houve o crescimento de bactérias aeróbias na bile vesicular em 3/16 (18,8 por cento) e no sangue portal em 1/16 (6,3 por cento), nao se observando o crescimento de bactérias anaeróbias. Em relaçao ao sangue da veia hepática esquerda e do tecido hepático, nao houve o isolamento de bactérias aeróbias e anaeróbias em todas as semeaduras realizadas. Nao foi possível verificar a disseminaçao bacteriana pelo sangue portal, pois as bactérias isoladas no sangue portal e na bile foram concontradas isoladamente e em caes diferentes.

Pileflebitis y abscesos múltiples hepáticos en una apendicectomizado / Pileflebitis and hepatic multiple abscess in an apendicectomized patient

Un paciente joven operado de apendicitis aguda evoluciona hacia una pileflebitis y abscesos múltiples hepáticos pese a recibir antibióticos. Después de dos operaciones adicionales y de un largo tratamiento de antibióticos se logra su recuperación