A biliary tract obstruction complicated by acute appendicitis and portal vein thrombosis-a case report and review of literature

Introduction and importance: Acute appendicitis is one of the most common surgical diagnoses in clinical practice. In case of uncomplicated course, diagnosis and treatment do not cause significant difficulties. On the other hand, unrecognized or complicated appendicitis can rarely bring unusual complications that threaten the patient with delayed treatment rather than the course itself. Portal vein thrombosis, also known as pylephlebitis, with an incidence of 1/1000 acute admissions, certainly meets this statement. Case presentation: In this study, we present a successful treatment of advanced acute appendicitis complicating treatment of biliary obstruction. Due to the advanced inflammation with forced intestinal resection in the extent of right-sided hemicolectomy. And then successful conservative treatment of portal vein thrombosis in the surgical facility lasting a total of 6 weeks when the patient was discharged to home care without sequelae. Clinical discussion: The epidemiology, presentation, diagnosis and strategy of treatments as well as their outcomes were discussed. Conclusion: Portal vein thrombosis after acute appendicitis is rare. In case of unfavorable postoperative course with high inflammatory markers, temperatures, discomfort and abdominal pain, a CT scan is in order, which can easily establish the diagnosis and subsequently target the treatment in the right direction. Treatment of pylephlebitis is conservative and long term. It consists in the application of low molecular weight heparin and targeted antibiotic treatment. The mortality rate is 32%.