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CASE REPORT
Pylephlebitis: a rare complication of an intra-abdominal infection
Katherine Wong, Medical Student1,2*, David S. Weisman, DO, FACP2 and Kelly-Ann Patrice, MD2
1Ross University School of Medicine, North Brunswick, NJ, USA; 2Good Samaritan Hospital, Department of Medicine, Baltimore, MD, USA
Abstract
Pylephlebitis is defined as an inflamed thrombosis of the portal vein. It is a rare complication of an intra-abdominal infection, and the diagnosis is often missed due to its nonspecific clinical presentation. Symptoms may include abdominal pain, fever, chills, fatigue, nausea, and vomiting. It is important to consider this differential when a patient presents with signs of abdominal sepsis since it has a high mortality rate and is often diagnosed postmortem. Pylephlebitis can be diagnosed via abdominal ultrasound or CT demonstrating a thrombus in the portal vein, and it must be treated early and aggressively with broad-spectrum antibiotics. We are presenting a case of pylephlebitis as well as discussing the diagnosis and treatment of this potentially lethal condition.
Keywords: pylephlebitis; portal vein thrombosis; abdominal infection; sepsis; diverticulitis; appendicitis; bacteroides
*Correspondence to: Katherine Wong, Department of Medicine, MedStar Good Samaritan Hospital, 5601 Loch Raven Blvd, Baltimore, MD 21239, USA, Email: [email protected]
Received: 28 February 2013; Revised: 23 April 2013; Accepted: 9 May 2013; Published: 5 July 2013
Journal of Community Hospital Internal Medicine Perspectives 2013. © 2013 Katherine Wong et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Citation: Journal of Community Hospital Internal Medicine Perspectives 2013, 3 : 20732 - http://dx.doi.org/10.3402/jchimp.v3i2.20732
Pylephlebitis is defined as a suppurative and inflamed thrombosis of the portal vein (1), which is a rare but potentially lethal complication of an intra-abdominal infection with a mortality rate of 25%. This condition can be difficult to diagnose due to its non-specific clinical presentation. However, it can be treated with early and aggressive intervention. It is important to keep this diagnosis on the differential of abdominal pain as it is associated with many common intra-abdominal pathological conditions and carries with it a high morbidity and mortality rate.
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