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

Abstract

Suppurative portal vein thrombosis (pylephlebitis) is an uncommon condition usually associated with an intra-abdominal infection or inflammatory process. In this study, we aimed to synthesize data on previously published cases according to the PRISMA guidelines. A total of 103 patients were included. Patients were more commonly male (71.8%) and had a mean age of 49 years. The most common infection associated with pylephlebitis was diverticulitis (n = 29, 28.2%), and Escherichia coli was the most isolated pathogen (n = 21, 20.4%). Blood cultures were positive in 64 cases (62.1%). The most common site of thrombosis was the main portal vein (PV) in 59 patients (57.3%), followed by the superior mesenteric vein (SMV) in 40 patients (38.8%) and the right branch of the PV in 30 patients (29.1%). Sepsis developed in 60 patients (58.3%). The mortality rate in our review was 8.7%, and independent risk factors for mortality were the presence of pertinent comorbidities (OR 5.5, p = 0.02), positive blood cultures (OR 2.2, p = 0.02), and sepsis (OR 17.2, p = 0.049).

Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis

“…There were 27 (12.3%) patients under 18 years of age, 6 (2.7%) individuals younger than 1 year, and the youngest reported case was only 20 days old. The diagnosis of liver cirrhosis was never reported in patients published before 2010 [207] but was present in approximately 4.9% of cases published between 2010 and 2022 [208].…”

“…A pathogen was not identified or not reported in 30% of the included cases. Previous studies reported positive blood cultures in 23-62.1% of cases [205,207,208]. Even though infections caused by multiple pathogens can present worse clinical outcomes [211], a recent study failed to demonstrate worse clinical course, duration of hospitalization, therapy, and outcomes in patients with polymicrobial infection [212].…”

“…Even though infections caused by multiple pathogens can present worse clinical outcomes [211], a recent study failed to demonstrate worse clinical course, duration of hospitalization, therapy, and outcomes in patients with polymicrobial infection [212]. In addition, Jevtic et al reported that polymicrobial infection did not increase mortality risk [208].…”

“…However, all these symptoms are common in intra-abdominal infections, which are the causative factor for the development of pylephlebitis, thus resulting in challenges to differentiate between symptoms caused by pylephlebitis or by the original infective process that caused pylephlebitis in the first place. Interestingly, in most of the reported cases, imaging leading to pylephlebitis diagnosis was performed to investigate the presence of intra-abdominal infective foci, with physicians not suspecting pylephlebitis and incidentally discovering portal vein involvement [208].…”

“…Leukocytosis is a common finding (80-89.7%) in pylephlebitis [207,208], even if both a normal leucocyte count [44,48,65] and neutropenia [213] were reported. Besides, most patients show high C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR), 90.9% and 85.7%, respectively [207,208].…”