In Reply to: Case 0100_04 -- Portal Vein Thrombophlebitis in Behcet's Disease. Is Catheter Directed Thrombolysis Warranted? posted by Editor on December 30, 1999 at 14:23:03:
This is a rare entity and a scary one. Here are some references:
Baddley JW; Singh D; Correa P; Persich NJ. Crohn's disease presenting as septic thrombophlebitis of the portal vein pylephlebitis): case report and review of the literature. American Journal of Gastroenterology, 1999 Mar, 94(3):847-9.
Lim HE; Cheong HJ; Woo HJ; Kim WJ; Kim MJ; Lee CH; Park SC. Pylephlebitis associated with appendicitis. Korean Journal of Internal Medicine, 1999 Jan, 14(1):73-6.
In these cases IV antibiotics alone did the trick. The problem with thrombolytics is that there is no outflow to this portal vein. The outflow are the abscesses. I would be afraid of further dissemination of the infection with thrombolytics. It would make some sense to infuse antibiotics directly into the portal system and to constantly aspirate and flush the pus. I am surprised that the patient survived.