A Case of Acute Appendicitis with Portal Vein Thrombosis

Abstract

A 63-year-old woman presented to our gastroenterology department with persistent right lower abdominal pain and fever for 13 days and jaundice. Blood tests showed an elevated inflammatory response and elevated hepatobiliary enzymes, and computed tomography (CT) showed thickening of the gallbladder wall. She was diagnosed as having cholecystitis and underwent emergent percutaneous transhepatic gallbladder drainage. On the following day, contrast-enhanced CT of the abdomen was performed because the inflammatory response had not improved. It showed an enlarged appendix and areas of poor contrast enhancement in the portal vein. She was diagnosed as having acute appendicitis and portal vein thrombosis and underwent emergency laparoscopic appendectomy to control inflammation. On postoperative day 1, anticoagulant therapy with heparin was begun. As the postoperative inflammatory response tended to improve, the heparin was replaced with rivaroxaban on the 6^th postoperative day. Contrast-enhanced abdominal CT on the 10^th postoperative day showed reduction of the portal vein thrombus. After the inflammatory response had normalized, the patient was discharged from the hospital on the 22nd postoperative day. A case of acute appendicitis complicated by portal vein thrombosis is reported.