Pylephlebitis: a Review of 95 Cases.

Pylephlebitis, or suppurative thrombophlebitis of the portal mesenteric venous system occurring in the setting of abdominal inflammatory processes, is a rare but deadly disease commonly associated with diverticulitis. We review our institutional experience in the management of patients with this condition. A retrospective review of medical records from 2002 to 2012 was performed. Patients with a portal mesenteric vein thrombosis (PMVT) within 30 days of an intra-abdominal inflammatory process were identified and evaluated. Ninety-five patients were included. The mean patient age at presentation was 57 years (range, 24-88). The most common associated processes were pancreatitis (31 %), followed by diverticulitis (19 %). Bacteremia was noted in 34 (44 %) patients. The most common organism cultured was Streptococcus viridans. Antibiotic and anticoagulation therapy was given in 86 (91 %) and 78 (82 %) patients, respectively. Overall, we report an 11 % mortality rate. Albeit rare, pylephlebitis most commonly was manifested in the setting of pancreatitis. Treatment should be individualized to culture results and extent of thrombosis. If diagnosed early and managed appropriately, a favorable outcome is possible.

Intussusception in adults and the role of evolving computed tomography technology.

BACKGROUND: The purpose of this study was to describe a single institution's experience with adult intussusception and determine how this was influenced by evolving computed tomography (CT) technology. METHODS: Adults treated between 1978 and 2013 for intussusception were reviewed. CT utilization and utilization of multislice technology over time were determined. Sensitivity of CT was calculated. RESULTS: A total of 318 patients were identified. CT utilization was 72% and it increased over time. The number of channels ranged from 1 to 128. CT sensitivity was greater than 85% for single and multislice scanners. A lead point was identified in 69% of patients and a malignancy in 40%. Surgical exploration was required in 60% of patients and 40% were managed nonoperatively. CONCLUSIONS: The diagnosis of intussusception in adults is increasing over time, particularly idiopathic intussusception. This is associated with increased utilization of highly sensitive CT technology, which facilitates the safe nonoperative management in many patients.

Endoscopy in the early postoperative setting after primary gastrointestinal anastomosis.

INTRODUCTION: Gastrointestinal anastomoses may require early evaluation and treatment via flexible endoscopic techniques when complications arise. There is reticence, however, to perform endoscopy given the applied mechanical forces. We aimed to identify the incidence of gastrointestinal anastomotic perforation or disruption resulting from endoscopy performed ≤6 weeks of anastomoses. METHODS: Review of patients from 2002 to 2013 who underwent flexible endoscopy within 6 weeks of creation of gastrointestinal anastomosis. Exclusion criteria included intraoperative endoscopy, anastomotic perforation prior to endoscopy, and endoscopy remote from the anastomotic site. Data are presented as median (interquartile range; IQR) or percentages as appropriate. RESULTS: Twenty-four patients met our criteria (age 69 years [IQR 54-77], 54% men]). Endoscopy was performed at a median postoperative time of 18 days (IQR 8-30). Indications for endoscopy included bleeding (66%), obstruction (13%), pain (13%), concern for pancreatic duct leak (4%), and concern for ischemia (4%). Six patients underwent therapeutic endoscopic procedures including coagulation (8%), balloon dilation (8%), tube decompression (8%), and stent placement (4%). There were no anastomotic perforations or disruptions as a result of endoscopy. CONCLUSION: Despite theoretical risks of adverse events of flexible endoscopy in the early postoperative period, no endoscopic perforations or disruptions occurred in recently created surgical anastomoses.