A 12-year-old Asian boy with a diagnosis of acute lymphocytic leukemia received induction chemotherapy with good response. One month later, during the intensification phase of his chemotherapy, he was admitted to the hospital for abdominal pain.
On physical examination he appeared to be in poor physical health with generalized abdominal tenderness. Abnormal laboratory values included an erythrocyte sedimentation rate of 66 mm/h, and elevated amylase, aspartate aminotransferase, and alkaline phosphatase levels. The patient continued to reach temperatures of 39.4°C, despite antibiotic therapy with cephalothin, gentamicin sulfate, and carbenicillin disodium. His condition deteriorated, and he was taken to the operating room for exploratory laparotomy following computed tomographic (Fig 1) and gallium 67 citrate (Fig 2) studies.
Denouement and Discussion
Pylephlebitis Secondary to Unsuspected Appendiceal Rupture
On exploratory laparotomy, the patient was found to have a ruptured appendix with microabscess formation in both lobes of the liver (pylephlebitis), an unusual complication of