INTRODUCTION: Pylephlebitis is defined as septic thrombophlebitis of the portal venous system, usually secondary to infection or inflammation in the abdomen. In the current report, we present a case of pylephlebitis that complicated the course of a very common pathology, diverticulitis. CASE PRESENTATION: A 62-year-old Caucasian woman with a history of sigmoid diverticulitis presented to our facility with a three-week history of abdominal pain, fevers, chills, loss of appetite and fatigue. Her laboratory test results showed leukocytosis and elevated alkaline phosphatase. A computed tomography scan revealed portal vein thrombosis and a sigmoid diverticulitis with an abscess. Our patient was given pipercillin-tozabactam followed by sigmoid colectomy and loop transverse colostomy. A peritoneal fluid sample culture grew Escherichia coli. Our patient had an uneventful post-operative course and the leukocytosis resolved in the next four days. She improved clinically and was discharged home on ertapenem and enoxaparin. A follow-up computed tomography scan two weeks later showed a new pelvic abscess that was drained by a pigtail catheter but there was no change in the portal venous thrombus. A repeat computed tomography scan one month later revealed resolution of the pelvic abscess but persistence of portal vein thrombus, for which enoxaparin was continued. CONCLUSIONS: This is a classic case of pylephlebitis that demonstrates the importance of recognizing that the portal vein thrombus is infected and treating the condition appropriately.
INTRODUCTION: Pylephlebitis is defined as septic thrombophlebitis of the portal venous system, usually secondary to infection or inflammation in the abdomen. In the current report, we present a case of pylephlebitis that complicated the course of a very common pathology, diverticulitis. CASE PRESENTATION: A 62-year-old Caucasian woman with a history of sigmoid diverticulitis presented to our facility with a three-week history of abdominal pain, fevers, chills, loss of appetite and fatigue. Her laboratory test results showed leukocytosis and elevated alkaline phosphatase. A computed tomography scan revealed portal vein thrombosis and a sigmoid diverticulitis with an abscess. Our patient was given pipercillin-tozabactam followed by sigmoid colectomy and loop transverse colostomy. A peritoneal fluid sample culture grew Escherichia coli. Our patient had an uneventful post-operative course and the leukocytosis resolved in the next four days. She improved clinically and was discharged home on ertapenem and enoxaparin. A follow-up computed tomography scan two weeks later showed a new pelvic abscess that was drained by a pigtail catheter but there was no change in the portal venous thrombus. A repeat computed tomography scan one month later revealed resolution of the pelvic abscess but persistence of portal vein thrombus, for which enoxaparin was continued. CONCLUSIONS: This is a classic case of pylephlebitis that demonstrates the importance of recognizing that the portal vein thrombus is infected and treating the condition appropriately.
Authors: K Zirinsky; J A Markisz; W A Rubenstein; P T Cahill; R J Knowles; Y H Auh; H Morrison; E Kazam Journal: AJR Am J Roentgenol Date: 1988-02 Impact factor: 3.959
Authors: Dorde Jevtic; Tatjana Gavrancic; Ivana Pantic; Terri Nordin; Charles W Nordstrom; Marina Antic; Nikola Pantic; Marija Kaljevic; Bojan Joksimovic; Milan Jovanovic; Emilia Petcu; Mladen Jecmenica; Tamara Milovanovic; Lawrence Sprecher; Igor Dumic Journal: J Clin Med Date: 2022-08-25 Impact factor: 4.964