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August 18, 1945


JAMA. 1945;128(16):1159-1161. doi:10.1001/jama.1945.92860330001008

Pylephlebitis is an inflammation of the portal vein caused by an acute suppurative process in that part of the abdomen drained by the portal vein. The disease carries a high mortality because of the multiple embolic liver abscesses arising from the infected thrombi in the portal system.

The most common condition causing this disease is acute appendicitis; however, gangrenous cholecystitis, infected thrombotic hemorrhoids, diverticulitis or pelvic suppuration may precipitate a portal thrombosis.

The case reported here followed an acute attack of appendicitis, so I shall confine the discussion to this disease.

In 1897 Armstrong1 reporting in England, stated that this complication caused 5 per cent of the deaths due to appendicitis. Hawkes2 in 1938 analyzed a series of 1,463 cases of acute appendicitis in which portal thrombosis occurred but 12 times. This lowered incidence can be attributed to earlier operative intervention in acute appendicitis.

PATHOLOGY  According to Crossland3 pylephlebitis