Reviewer's report 
 Septic thrombophlebitis of the mesenteric vein and multiple liver abscesses in a patient with Crohn`s Title: 
disease at onset. 
 2  19 November 2006 Version: Date: 
 Alessandro Fichera Reviewer: 
Reviewer's report: 
General 
Dr. Aguas and his colleague have reported an interesting case of septic thrombophlebitis in a patient with Crohn’s disease complicated by multiple liver abscesses. This is a dreaded and serious complication of a very common disease that has not been adequately reported in the literature. The Case Report is well 
written and the Discussion is quite comprehensive. There are several minor essential revisions that need to 
be made. 
------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
? In the Presentation of the Case, at the last paragraph the authors mention that previous to surgical 
intervention a CT scan showed complete resolution of the liver abscesses and recanalization of the superior 
mesenteric vein and they quote Figure no. 2. Figure no. 2 in the attached figures shows the preoperative 
portal vein thrombosis and not the mentioned picture. It would be interesting to have a figure showing the 
recanalization as Figure no. 3 added at this point. Further, a figure showing the actual site of active Crohn’s 
disease at the time of surgery will clearly add to the paper. The authors state that “Crohn’s disease was not 
complicated by an abscess but only stricturing disease; however, they report an inflammatory mass on 
physical exam. They should, therefore, show the CT scan that ruled out an abscess at the level of the 
terminal ileum. Clearly the septic process started in the affected segment of Crohn’s disease and either by bacterial translocation or due to the presence of a right lower quadrant abscess. 
? In the Discussion, in the first few paragraphs, the author discussed the hypercoagulable condition that 
was apparently ruled out. There are no details of the hypercoagulable work-up that in our practice include 
several congenital hypercoagulable states. More details on the hypercoagulable work-up would be very 
helpful in the understanding of this situation. 
? It is important for the authors to state that the subsequent surgical resection of the affected ileum was 
warranted by the severe complication associated with the flare. Their statement “in the case in question, 
although the hepatic abscesses resolved with conservative treatment, we decided to perform a subsequent 
surgical resection to the affected ileum” should be changed since the resection of the affected ileum was 
clearly indicated by the presence of the hepatic abscesses. 
? The sentence: “Abdominal surgery, long term treatment with steroids or metronidazole, inflammatory and 
perforating disease, fistulae and intraabdominal abscesses and malnutrition are among the said factors.” 
“should be rewritten changing “said” with “those”. 
? In the following sentence: “In the literature most patients with liver abscesses suffer from long term IBD 
although there have been reports of Crohn’s disease manifesting itself in said complications” should read 
“In the literature most patients with liver abscesses have a long-standing history of IBD although reports of Crohn’s disease presenting de novo with hepatic abscess have been presented. 
? The explanation of the etiology of the case that the authors offer at the end of the Discussion is 
completely speculative and should be eliminated. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
Reviewer's report 
 Septic thrombophlebitis of the mesenteric vein and multiple liver abscesses in a patient with Crohn`s Title: 
disease at onset. 
 2  19 November 2006 Version: Date: 
 Alessandro Fichera Reviewer: 
Reviewer's report: 
General 
Dr. Aguas and his colleague have reported an interesting case of septic thrombophlebitis in a patient with Crohn’s disease complicated by multiple liver abscesses. This is a dreaded and serious complication of a very common disease that has not been adequately reported in the literature. The Case Report is well 
written and the Discussion is quite comprehensive. There are several minor essential revisions that need to 
be made. 
------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
? In the Presentation of the Case, at the last paragraph the authors mention that previous to surgical 
intervention a CT scan showed complete resolution of the liver abscesses and recanalization of the superior 
mesenteric vein and they quote Figure no. 2. Figure no. 2 in the attached figures shows the preoperative 
portal vein thrombosis and not the mentioned picture. It would be interesting to have a figure showing the 
recanalization as Figure no. 3 added at this point. Further, a figure showing the actual site of active Crohn’s 
disease at the time of surgery will clearly add to the paper. The authors state that “Crohn’s disease was not 
complicated by an abscess but only stricturing disease; however, they report an inflammatory mass on 
physical exam. They should, therefore, show the CT scan that ruled out an abscess at the level of the 
terminal ileum. Clearly the septic process started in the affected segment of Crohn’s disease and either by bacterial translocation or due to the presence of a right lower quadrant abscess. 
? In the Discussion, in the first few paragraphs, the author discussed the hypercoagulable condition that 
was apparently ruled out. There are no details of the hypercoagulable work-up that in our practice include 
several congenital hypercoagulable states. More details on the hypercoagulable work-up would be very 
helpful in the understanding of this situation. 
? It is important for the authors to state that the subsequent surgical resection of the affected ileum was 
warranted by the severe complication associated with the flare. Their statement “in the case in question, 
although the hepatic abscesses resolved with conservative treatment, we decided to perform a subsequent 
surgical resection to the affected ileum” should be changed since the resection of the affected ileum was 
clearly indicated by the presence of the hepatic abscesses. 
? The sentence: “Abdominal surgery, long term treatment with steroids or metronidazole, inflammatory and 
perforating disease, fistulae and intraabdominal abscesses and malnutrition are among the said factors.” 
“should be rewritten changing “said” with “those”. 
? In the following sentence: “In the literature most patients with liver abscesses suffer from long term IBD 
although there have been reports of Crohn’s disease manifesting itself in said complications” should read 
“In the literature most patients with liver abscesses have a long-standing history of IBD although reports of Crohn’s disease presenting de novo with hepatic abscess have been presented. 
? The explanation of the etiology of the case that the authors offer at the end of the Discussion is 
completely speculative and should be eliminated. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
Please review this paper.
user
Reviewer's report 
 Septic thrombophlebitis of the mesenteric vein and multiple liver abscesses in a patient with Crohn`s Title: 
disease at onset. 
 2  19 November 2006 Version: Date: 
 Alessandro Fichera Reviewer: 
Reviewer's report: 
General 
Dr. Aguas and his colleague have reported an interesting case of septic thrombophlebitis in a patient with Crohn’s disease complicated by multiple liver abscesses. This is a dreaded and serious complication of a very common disease that has not been adequately reported in the literature. The Case Report is well 
written and the Discussion is quite comprehensive. There are several minor essential revisions that need to 
be made. 
------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
? In the Presentation of the Case, at the last paragraph the authors mention that previous to surgical 
intervention a CT scan showed complete resolution of the liver abscesses and recanalization of the superior 
mesenteric vein and they quote Figure no. 2. Figure no. 2 in the attached figures shows the preoperative 
portal vein thrombosis and not the mentioned picture. It would be interesting to have a figure showing the 
recanalization as Figure no. 3 added at this point. Further, a figure showing the actual site of active Crohn’s 
disease at the time of surgery will clearly add to the paper. The authors state that “Crohn’s disease was not 
complicated by an abscess but only stricturing disease; however, they report an inflammatory mass on 
physical exam. They should, therefore, show the CT scan that ruled out an abscess at the level of the 
terminal ileum. Clearly the septic process started in the affected segment of Crohn’s disease and either by bacterial translocation or due to the presence of a right lower quadrant abscess. 
? In the Discussion, in the first few paragraphs, the author discussed the hypercoagulable condition that 
was apparently ruled out. There are no details of the hypercoagulable work-up that in our practice include 
several congenital hypercoagulable states. More details on the hypercoagulable work-up would be very 
helpful in the understanding of this situation. 
? It is important for the authors to state that the subsequent surgical resection of the affected ileum was 
warranted by the severe complication associated with the flare. Their statement “in the case in question, 
although the hepatic abscesses resolved with conservative treatment, we decided to perform a subsequent 
surgical resection to the affected ileum” should be changed since the resection of the affected ileum was 
clearly indicated by the presence of the hepatic abscesses. 
? The sentence: “Abdominal surgery, long term treatment with steroids or metronidazole, inflammatory and 
perforating disease, fistulae and intraabdominal abscesses and malnutrition are among the said factors.” 
“should be rewritten changing “said” with “those”. 
? In the following sentence: “In the literature most patients with liver abscesses suffer from long term IBD 
although there have been reports of Crohn’s disease manifesting itself in said complications” should read 
“In the literature most patients with liver abscesses have a long-standing history of IBD although reports of Crohn’s disease presenting de novo with hepatic abscess have been presented. 
? The explanation of the etiology of the case that the authors offer at the end of the Discussion is 
completely speculative and should be eliminated. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
assistant