Septic Pylephlebitis as a Rare Complication of Crohn's Disease

Abstract

Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections. (Korean J Gastroenterol 2013;61:219-224)

Inferior Mesenteric Vein Thrombosis Resulting in Pylephlebitis in a Patient With Inflammatory Bowel Disease

“…The SMV is more commonly thrombosed, and studies suggest that MVTs are found within the same territory in which IBD is located. 9 Our case follows a similar presentation. The prevalence of MVT remains unknown within the IBD population; however, the risk seems to be increased and is speculated to be 8 times higher during a flare.…”

“…Bowel wall inflammation and localized venous engorgement from MVT could be correlating factors. 9 Pylephlebitis may ensue after bacteria translocate from the site of bowel damage or infection into small veins, draining this area and then become thrombosed. This process extends to involve the portal vein and/or mesenteric veins.…”

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 ,…”

Pylephlebitis and Crohn’s disease: A rare case of septic shock

“…It is usually secondary to the development of intra-abdominal infective foci typically complicating diverticular disease, appendicitis and necrotizing pancreatitis [2] . This critical clinical condition can arise in inflammatory bowel diseases too [2] , [3] , [4] , [5] , [6] , [7] , [8] . However, in Crohn’s disease it is extremely rare.…”

“…Pylephlebitis was described as a Crohn’s disease complication in 1946 by Taylor [3] and, to the best of our knowledge, only other 8 cases have been reported so far [2] , [4] , [5] , [6] , [7] , [8] . Furthermore, only in three of them the superior mesenteric vein was described to be primarily involved.…”