Published online Jan 27, 2019. doi: 10.4254/wjh.v11.i1.133
Peer-review started: September 18, 2018
First decision: October 18, 2018
Revised: November 4, 2018
Accepted: December 6, 2018
Article in press: December 7, 2018
Published online: January 27, 2019
Processing time: 131 Days and 21.3 Hours
Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. We here report the management of a 54-year-old woman operated for a peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a hepatectomy.
This patient was operated by left lobectomy extended to segment V with bile duct resection and Roux-en-Y hepaticojejunostomy. After the surgery, she developed Streptococcus anginosus, Escherichia coli, and Enterococcus faecium bacteraemias, as well as Candida albicans fungemia. A computed tomography scan revealed a bilioma which was percutaneously drained. Despite adequate antibiotic therapy, the patient’s condition remained septic. A diagnosis of septic thrombophlebitis of the vena cava was made on post-operative day 25. The patient was then operated again for a surgical thrombectomy and complete caval reconstruction with a parietal peritoneum tube graft. Use of the peritoneum as a vascular graft is an inexpensive technique, it is readily and rapidly available, and it allows caval replacement in a septic area. Septic thrombophlebitis of the vena cava after hepatectomy has not been described previously and it warrants being added to the spectrum of potential complications of this procedure.
Septic thrombophlebitis of the vena cava was successfully treated with antibiotic and anticoagulation treatments, prompt surgical thrombectomy and caval reconstruction.
Core tip: Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. Its evolution into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. This study reports the management of a 54-year-old woman with peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a hepatectomy. A combination of antibiotic and anticoagulation treatments, prompt surgical thrombectomy and complete caval reconstruction was associated with a favorable outcome. Use of the peritoneum as a vascular graft is an inexpensive technique, and it allows caval replacement in a septic area.