Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein

Abstract

Thrombophlebitis of the portal vein (pylephlebitis) is a rare but serious condition with a high mortality rate of 11-50%. A 56-year-old male patient presented with a two-day history of postprandial, colic-like epigastric pain, nausea, fever, chills, and diarrhea. Clinical workup showed peritonism, leukocytosis, and elevated C-reactive protein (CRP). A computed tomography (CT) scan revealed a long-segment, partial thrombosis of the superior mesenteric vein as well as gas in the portal venous system. Additionally, extensive jejunal diverticulosis was present. Pylephlebitis mostly results from intestinal infections, e.g., appendicitis or diverticulitis. We assumed that the patient had suffered from a self-limiting episode of jejunal diverticulitis leading to septic thrombosis. Initially, antibiotic therapy and anticoagulation with heparin were administered. The patient deteriorated, and due to increasing abdominal defense, fever, and hypotension, a diagnostic laparoscopy was performed. Bowel ischemia could be ruled out, and after changing antibiotic therapy, the patient’s condition improved. He was discharged without any further complications and without complaints on day 13. An underlying coagulopathy like myeloproliferative neoplasm or antiphospholipid syndrome could be ruled out.

Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature

“…Articles published in languages other than English; cases where clinical, microbiological, or radiological studies did not support the diagnosis; case reports not providing an adequate amount of information, as well as those reporting non-human subjects were excluded from the analyses. The final number of articles included was 101, which resulted in total number of 103 patients [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ,…”

Structural and functional alterations of intestinal flora in mice induced by halonitromethanes exposure

“…Previous studies have shown that some bacteria among Acinetobacter, are opportunistic pathogens causing gastroenteritis such as Acinetobacter lwoffii and Acinetobacter johnsonii (Palmisano et al, 2020). Meanwhile, Morganella, Proteus, Veillonella, Actinomyces, Prevotella, Clostridium, Granulicatella were significantly enriched in the least one BNM, BCNM, or TCNM exposure group, which have been proved to be closely related to gastroenteritis (Hamilton et al, 2018;Li et al, 2018;Kiu et al, 2019;Bockmeyer et al, 2020;Iljazovic et al, 2021;Tian et al, 2022;Zhan et al, 2022). Accumulating evidence strongly suggests that intestinal dysbacteriosis and enteritis-associated pathogens bloom are important causes of intestinal inflammation, lesions, and even cancer (Gao et al, 2018;Khan et al, 2019;Liu et al, 2021).…”

Fatal superior mesenteric vein thrombosis due to acute Appendicitis in an elderly patient

“…This physio pathologic mechanism was proven in the 70s. The most common involved abdominal infection is colonic diverticulitis, then appendicitis and cholecystitis [2] . The incidence of septic thrombophlebitis of the porto-mesenteric veins due to acute appendicitis was close to 0.4% before 1950.…”