Indian J Pediatr DOI 10.1007/s12098-015-1817-0


Acute Appendicitis Complicated with Ileocolic Vein Thrombosis Satoshi Sato 1 & Hidekuni Takahashi 1 & Miki Sato 1 & Maria Yokoyama 1 & Yutaka Hayashi 2 & Hisashi Kawashima 1

Received: 5 March 2015 / Accepted: 9 June 2015 # Dr. K C Chaudhuri Foundation 2015

To the Editor: Very few cases of disseminated intravascular coagulation (DIC) causing ileocolic vein thrombosis and splenic infarction have been reported as a complication of acute appendicitis. A 15-y-old boy presented to the department with abdominal pain and fever. On admission, his body temperature was 37.9 °C, abdomen was flat, pain in the right lower abdominal region was mild, and no rebound tenderness was noted. Blood tests showed the following: white blood cell count 13,100/uL, and platelet count was low (80,000/uL). The fibrin degradation products were high at 30.9 μg/ml. Prothrombin time was 16.2 s. Activated partial thromboplastin time was 48.9 s. He was diagnosed with DIC.

Abdominal contrast-enhanced computed tomography (CT) showed increased radiodensity of the enlarged appendix and surrounding adipose tissue. We planned to conservatively manage the acute appendicitis. Because his fever persisted, abdominal CT was performed again, and the result showed no remarkable changes in the appendicitis. However, a vine-like low-density area along the ileocolic vein and low-density area of the spleen were observed (Fig. 1a, b). We suspected ileocolic vein thrombosis and splenic infarction and an appendectomy was performed. Intraoperatively, although the appendix adhered to the surrounding tissues, it could be detached. The appendix was markedly thickened and

Fig. 1 Abdominal contrastenhanced computed tomography on the 6th day of hospital admission showing (a) a low density area along the ileocolic vein and (b) low density area of the spleen


* Satoshi Sato [email protected] 1

Department of Pediatrics, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan


Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan


Indian J Pediatr Fig. 2 (a) Photomicrograph revealing appendicitis with infiltration of neutrophils, edema and hemorrhage as well as (b) venous thrombosis in the mesoappendix

a no sign of necrosis was noted in the intestine, mesentery, or spleen. Histopathological examinations indicated acute phlegmonous appendicitis, and thrombi were observed in the vascular wall in the mesoappendix (Fig. 2a, b). The postoperative course was uneventful. Abdominal CT on the 6th postoperative month showed no sign of recurrence of thrombosis. Venous thrombosis with childhood appendicitis is relatively rare [1–3]. When ileocolic vein thrombosis and splenic infarction are caused by appendicitis, as in our patient, the following mechanisms of thrombogenesis are considered possible: thrombi form locally owing to a state of DIC and a hyperinflammatory condition that extends into the vascular lumens. In our patient, the histopathological examination identified a thrombus in the blood vessels of the mesoappendix, but the details

b of the ileocolic vein and splenic infarction were not clear. Conflict of Interest None. Source of Funding None.

References 1. 2.


Levin C, Koren A, Miron D, et al. Pylephlebitis due to perforated appendicitis in a teenager. Eur J Pediatr. 2009;168:633–5. Takehara K, Miyano S, Machida M, Kitabatake T, Fujisawa M, Kojima K. Superior mesenteric vein thrombosis as a complication of acute appendicitis: report of a case. Clin J Gastroenterol. 2013;6:269–73. Soh KS, Hsieh CH, Wu SC, et al. Septic thrombophlebitis with superior mesenteric venous thrombosis after laparoscopic appendectomy for uncomplicated acute appendicitis. Am Surg. 2010;76:E186–7.

Acute Appendicitis Complicated with Ileocolic Vein Thrombosis.

Acute Appendicitis Complicated with Ileocolic Vein Thrombosis. - PDF Download Free
425KB Sizes 0 Downloads 16 Views