Septic Pylephlebitis of the Inferior Mesenteric Vein Secondary to Diverticulitis: A Case Report

Abstract

Background:
Pylephebitis is a rare complication of intraabdominal infections, with diverticulitis being the most common inciting condition. Due to its high mortality rate, a high index of suspicion is needed, and proper diagnostic work-up including radiologic imaging is important.

Case Presentation:
We report a 56-year-old Filipino male, who presented with a one-week history of fever, chills and abdominal bloatedness. Physical examination showed icteric sclerae and epigastric tenderness. Laboratory tests showed leukocytosis and liver function typical of a cholestatic jaundice. Ultrasound of the abdomen showed acalculous cholecystitis and abdominal CT scan revealed sigmoid diverticulitis with pylephlebitis of the inferior mesenteric vein. He was started on intravenous piperacillin-tazobactam and heparin drip. Antibiotics were later shifted to intravenous meropenem and oral warfarin with eventual resolution of both the thrombosis and the diverticulitis.

Recommendation:
Septic pylephlebitis is associated with high morbidity and mortality. Early diagnosis with appropriate imaging is important in order to initiate life-saving therapy with antibiotics and anticoagulation.