Pylephlebitis—Diagnosis and Management

Septic thrombophlebitis of the superior mesenteric vein with bacteraemia caused byBacteroides fragilisandStreptococcus intermediusas a complication of diverculitis

“…Regarding the aetiology, the most common underlying diseases associated with septic thrombophlebitis are diverticulitis (30%), appendicitis (19%) and inflammatory bowel disease (6%); other aetiologies include pancreatitis (5%), gastric/duodenal ulcer (2%) (including the present case), etc 1. Liver cirrhosis and hepatocellular carcinoma are also well-known risk factors for septic thrombophlebitis 4. In the present case, the diagnosis was made by radiographic imaging and not by the clinical findings.…”

“…The most common symptoms are fever, which occurs in 86–100% of the cases, and abdominal pain occurring in 74–82% of cases1 3; however, clinical diagnosis is difficult because the clinical features are non-specific, especially in cases without abdominal pain 4. Physical examination often reveals splenomegaly, hepatomegaly and ascites, however, the features of each of these were non-specific.…”

A Case of Pylephlebitis Secondary to Cecal Diverticulitis

“…However, anticoagulation in patients with thrombus isolated to the portal vein and normal clotting function may be unnecessary, as reported in a retrospective study of 44 cases (6). On the other hand, Singh et al report that anticoagulants did not have a significant impact on the outcomes of eight cases of pylephlebitis (11). Anticoagulation is not performed without risk, especially in the immediate postoperative period, and thus the benefits are all speculative (12).…”

Septic thrombophlebitis of the superior mesenteric vein and multiple liver abscesses in a patient with Crohn's disease at onset

“…A broad spectrum antibiotic coverage is crucial, but the appropriate timing of their administration is less clear. Given the frequency of hepatic abscesses as a complication of pylephlebitis, and since they may not be visualized in a CT scan (with or without drainage), a minimum of 6 weeks antibiotic therapy seems prudent [13,14]. The role of anticoagulation or thrombolytic therapy in the treatment of pylephlebitis in the setting of IBD has not been standardized, but systemic anticoagulation for a minimum of 6 months has been recommended.…”