Unrecognized pylephlebitis causing life-threatening septic shock: A case report

Abstract

A man who developed profound septic shock was treated for Escherichia coli sepsis of unknown origin. Following stabilisation, a diagnosis of pylephlebitis (infection and thrombosis in the portal vein) was made at computed tomography. A review of the condition, its primary causes, typical features, investigation and management was presented.

A Case of Fulminant Portal Pyemia Complicating Hemicolectomy for Polyps: Literature Review and Case Report

“…Polymicrobial cultures involving different streptococcal species are characteristic. 5 In this case, there was no evidence of underlying intestinal sepsis to account for the extensive intramural gas and portal pyemia that was seen intraoperatively. Gas within the biliary tree as demonstrated on CT would indicate the presence of gas-forming organisms; however, no pus was seen intraoperatively and cultures failed to demonstrate the presence of such organisms.…”

Pylephlebitis due to perforated appendicitis in a teenager

“…Even with aggressive therapy, the occurrence of severe complications, including liver abscesses, septic shock, mesenteric necrosis, pulmonary emboli and death, is high [3,5,10,13,15]. The clinical presentation of pylephlebitis is usually nonspecific and includes high fever [1,5,10], abdominal pain and anorexia [5]; sepsis [10]; hepatomegaly or hepatosplenomegaly can be seen at a lower frequency [14].…”

Fatal hemorrhage due to thrombosis and rupture of the portal vein and hepatic artery

“…Another potential cause is an intra-abdominal infection. The combination of infection and thrombosis within the portal vein comprises pylephlebitis (thrombophlebitis of the portal vein and/or of its branches) [5][6]. Pylephlebitis is a secondary phenomenon subsequent to sepsis affecting parts of the gastrointestinal tract drained by the portal vein or structures adjacent to it.…”