Pylephlebitis

Presentation

It typically presents with fever, rigors, and right upper quadrant abdominal pain, but sometimes abdominal pain may be absent. Liver function test abnormalities are usually present but frank jaundice is uncommon.

Cause

It is a cause of portal hypertension and can cause bowel ischemia sometimes leading to bowel infarction. Diverticulitis (26.5%) and acute appendicitis (22%) are the two most common causes. Pylephlebitis is caused by a single pathogen in 43% of cases and polymicrobial in 27% of cases. The most frequently isolated bacteria are Escherichia coli (25%), Bacteroides spp. (17%), and Streptococcus spp. (15%).

Diagnosis

In the modern era, it is usually diagnosed by CT scans of the abdomen and pelvis. Bacteriology is often polymicrobial and blood cultures are positive in some cases. A significant fraction of people presenting with this condition have an underlying hypercoagulable state.

Treatment

Treatment is with a prolonged course of broad-spectrum antibiotics, with the addition of anticoagulants if other clots are present outside the portal vein or if fever persists on antibiotic therapy.

References

• Kumar, V.; Abbas, A. K.; Fausto, N.; Robbins, S. L.; Cotran, R. S. (2015). Robbins and Cotran Pathologic Basis of Disease, 9th ed.; Philadelphia: Elsevier Saunders.
• Fusaro, Lisa; Di Bella, Stefano; Martingano, Paola; Crocè, Lory Saveria; Giuffrè, Mauro (2023). "Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis". Diagnostics. 13 (3): 429. doi:10.3390/diagnostics13030429. ISSN 2075-4418. PMC 9914785. PMID 36766534.