N Z Med J 2006; 119(1234): U1984 (Read article online)

Sakalkale R, Reeve P

Portal and mesenteric pyelephlebitis is a rarely recognised condition associated with a high morbidity. It usually develops secondary to infection in the drainage area of the portal venous system. We report a case of perforated acute appendicitis complicated by superior mesenteric venous pyelephlebitis and thrombocytopaenia. Appendicectomy and treatment with broad-spectrum antibiotics, anticoagulation, and platelets led to a full recovery. Follow-up imaging revealed complete resolution of the thrombosis. The literature is reviewed and the operative and non-operative approaches for the management of mesenteric and portal venous thrombosis are discussed.