A CASE OF APPENDICITIS WITH HYPERBILIRUBINEMIA AND SUPERIOR MESENTERIC VENOUS THROMBOSIS

Abstract

A 68-year-old man presented with fever on January 5, 2002. Because the fever did not go down by administration of antibiotics and jaundice developed, he was admitted to another hospital with a suspicion of acute hepatitis. However, no remission was attained and superior mesenteric venous thrombosis was confirmed. On January 21, the patient was transferred to the department of gastrointestinal medicine in our hospital. On admission to the hospital, the abdomen was flat and soft and no peritoneal signs were present. Examination of the blood revealed increases in the white blood cell count, CRP and total bilirubin levels. Abdominal ultrasonography and CT scan visualized the swollen liver, splenomegaly, superior mesenteric venous thrombosis, and an abscess with the diameter of 5 cm in the vicinity of the appendix. Culture of venous blood gave Gram negative bacillus. From these findings, the patient's conditions were thought to be due to appendicitis. The patient was referred to the department on January 23, and underwent an appendectomy and drainage on the same day. The appendix had perforated into the retroperitoneum to form the abscess.
Since this case which presented septicemia, superior mesenteric venous thrombosis, and hyperbilirubinemia without showing peritoneal signs is thought to be of value, we report the case together with some bibliographical comments.