A 17-year-old male with abdominal pain of eight days duration, fever and diarrhea.
Abdominal pain is diffuse without defense or peritonitis.
Analytical: 16,400 leukocytes/mm3 with neutrophilia.
Imaging: chest X-ray, abdomen and abdominal ultrasound were normal.
With the diagnosis of acute gastroenteritis the patient is discharged.
A week later, the patient presented with fever > 38 oC, abdominal pain in the right hypochondrium, vomiting, diarrhoea and jaundice.
Analytical: 9,000 leukocytes/mm3 with neutrophilia, hemoglobin 12.7 g/dl, 83,000 platelets, AST 423 IU/L, ALT 312 IU/L, total bilirubin 4.70 mg/dl, direct bilirubin
HBV, HCV, HAV, CMV and EBV serology were negative.
Blood cultures: gram-negative bacilli (E. coli and B. fragilis) and gram-positive cocci (S. species) are isolated.
Empirical antibiotic therapy was initiated with amoxicillin-clavulanic acid, suspected by ciprofloxacin and metronidazole due to the appearance of unknown allergy after 16 hours of treatment.
Abdominal CT shows a dilated appendix with atypical gas and inflammatory changes in relation to acute inflammatory colitis.
Hypodensity of the superior mesenteric vein and its branches with thickening of the vascular endothelium compatible with venous thrombosis.
Multiple patches of liver, hypodense areas and poorly defined margins.
Patent door and splenicy.
Surgery was performed on the patient who was diagnosed with authentic arthritis with localized peritonitis and no other intra-abdominal pathological findings.
Acquirement of cystectomy.
Postoperative treatment consists of parenteral nutrition, broad-spectrum antibiotics (Imipenem 1 g/8/4 weeks) and anticoagulation medication (pararolidocaine 0.8 cc/12 h/5 days and later/24 h), complet
A hypercoagulable state was ruled out.
One week after surgery, CT persistent thrombosis of the superior mesenteric vein progressing to partial thrombosis of the intrahepatic portal branches of segments II and III, without intrahepatic portal vein thrombosis.
Two months after discharge liver function tests are normal and control CT demonstrates the development of collateral circulation through colic veins.
