Mesenteric Venous Thrombophlebitis–Septic Thrombophlebitis of the Inferior Mesenteric Vein: An Unusual Manifestation of Diverticulitis

Abstract

We report a case of a 57-year-old female patient who presented with fever, abdominal pain, and bacteremia. A CT scan demonstrated sigmoid diverticulitis and air within the inferior mesenteric vein. The patient underwent exploratory laparotomy and sigmoid colectomy. She was discharged without complications. Septic thrombophlebitis of the inferior mesenteric vein is a rare complication of diverticulitis. It may manifest as bacteremia not responding to intravenous antibiotics. CT scan findings are diagnostic, and include evidence of intraluminal gas within the inferior mesenteric vein. As with any case of complicated diverticulitis, the treatment is surgical resection of the involved colon.

Pylephlebitis of the inferior mesenteric vein: a rare complication of sigmoid diverticulitis

“…No randomized control trials have identified empiric treatment regimes, and antibiotic choice is directed by local prescribing guidelines and subsequently targeted to culture and susceptibility where available. An ideal duration of treatment has yet to be determined, with previous case studies of pylephlebitis caused by diverticulitis using regimes between 7 and 21 days of treatment 6–9 . There is also no consensus in the literature for the use and duration of anticoagulation, with previous studies indicating that potential indicators for therapy include progression of thrombus on repeat imaging, continued fever despite antibiotic therapy, a hypercoagulable state or extension of thrombus beyond the portal vein and into mesenteric veins 10 .…”

“…An ideal duration of treatment has yet to be determined, with previous case studies of pylephlebitis caused by diverticulitis using regimes between 7 and 21 days of treatment. [6][7][8][9] There is also no consensus in the literature for the use and duration of anticoagulation, with previous studies indicating that potential indicators for therapy include progression of thrombus on repeat imaging, continued fever despite antibiotic therapy, a hypercoagulable state or extension of thrombus beyond the portal vein and into mesenteric veins. 10 Surgical management of the underlying aetiology may be indicated, but should be considered with regard to the patient's clinical picture.…”