Pylephlebitis: a rare complication of an intra-abdominal infection

Abstract

Pylephlebitis is defined as an inflamed thrombosis of the portal vein. It is a rare complication of an intra-abdominal infection, and the diagnosis is often missed due to its nonspecific clinical presentation. Symptoms may include abdominal pain, fever, chills, fatigue, nausea, and vomiting. It is important to consider this differential when a patient presents with signs of abdominal sepsis since it has a high mortality rate and is often diagnosed postmortem. Pylephlebitis can be diagnosed via abdominal ultrasound or CT demonstrating a thrombus in the portal vein, and it must be treated early and aggressively with broad-spectrum antibiotics. We are presenting a case of pylephlebitis as well as discussing the diagnosis and treatment of this potentially lethal condition.

Pylephlebitis: A Diagnostic Challenge

“…It is often a complication of intra-abdominal infection such as diverticulitis (most common), acute appendicitis, necrotizing pancreatitis, acute cholecystitis, colitis, inflammatory bowel disease, viscus perforation, hemorrhoidal disease, Behcet's syndrome or amebic colitis [2]. However, we cannot identify a primary source of infection in 70% of patients [3]. It can occur in all ages, but it seems to be more frequent in male (68-74%) [3].…”

“…Clinical presentation is usually variable and non-specific, making diagnosis difficult [6], and mortality rate is still high (25%) [3]. It can be asymptomatic or present with gastrointestinal symptoms (ex: abdominal pain, nausea, vomiting, and diarrhea), fever and constitutional symptoms (ex: fatigue, malaise, and anorexia/weight loss) [3].…”

“…However, a primary source of infection is not identified in 70% of patients [3]. It is usually polymicrobial [5], but the most common pathogens are Escherichia coli (54%) and Proteus mirabilis (23%) [1].…”

“…However, we cannot identify a primary source of infection in 70% of patients [3]. It can occur in all ages, but it seems to be more frequent in male (68-74%) [3].…”

“…Because of its non-specific clinical and laboratory presentation, the diagnosis can be delayed [3], which usually worsens the prognosis of the disease. The definitive diagnosis requires demonstration of portal vein thrombosis, usually accompanied by bacteremia and fever [4].…”