Pylephlebitis: A Case of Inferior Mesenteric Vein Thrombophlebitis in a Patient with Acute Sigmoid Diverticulitis—A Case Report and Clinical Management Review

Abstract

Pylephlebitis is a rare complication of intra-abdominal infections and describes thrombosis and infection as two different pathophysiological phenomena in the cause of this disease. The nonspecific presentation of disease makes its diagnosis difficult and thus leads to high mortality. The treatment comprises antibiotics and also includes controversial use of anticoagulation in these patients. Here, we present a patient with past medical history of human immunodeficiency virus and past diverticulitis who presented with fever, chills, diarrhea, neck pain, and photophobia. He was diagnosed with acute sigmoid diverticulitis with associated inferior mesenteric vein thrombophlebitis. He improved after intravenous antibiotics and anticoagulation and was discharged. He underwent sigmoid colectomy 3 months after his initial presentation and was advised to take anticoagulation for a total of 6 months.

Pylephlebitis With Splenic and Mesenteric Vein Thrombosis in a Patient With Diverticulitis

“…In a case report by Sherigar et al it was concluded that the indication for thrombolytic therapy was similar to that of using anticoagulation, that is, it can be used to prevent the progression of the thrombus and be used if a patient shows signs of portal hypertension, which is a complication associated with higher mortality [15]. At this time, there are no clinical trials that have commented on anticoagulation duration or have compared the efficacy of different types of anticoagulation regimens in patients with pylephlebitis [16]. Historically, patients have been treated with heparin, low molecular weight heparin, warfarin, and novel oral anticoagulants (NOACs), with a recent increase in the use of NOACs [16][17].…”

“…At this time, there are no clinical trials that have commented on anticoagulation duration or have compared the efficacy of different types of anticoagulation regimens in patients with pylephlebitis [16]. Historically, patients have been treated with heparin, low molecular weight heparin, warfarin, and novel oral anticoagulants (NOACs), with a recent increase in the use of NOACs [16][17].…”

Tromboflebite Séptica da Veia Porta como Complicação de Apendicite Aguda

“…[1][2][3][4][5][6][7][8][9] A TC na fase venosa portal é o meio complementar mais sensível, mas o diagnóstico final pode ser estabelecido através de ecografia com doppler ou TC com contraste, como no caso apresentado. [7][8][9] Uma vez estabelecido o diagnóstico e identificada a causa da tromboflebite, o tratamento deve ser iniciado de imediato com antibioterapia de largo espectro e hipocoagulação. 8,9 A antibioterapia constitui o principal tratamento para a pileflebite, sendo necessário início empírico para as bactérias mais comuns (Bacteroides fragilis, Escherichia coli e anaeróbios), devendo-se ajustar o antibiótico de acordo com o resultado cultural.…”

“…[7][8][9] Uma vez estabelecido o diagnóstico e identificada a causa da tromboflebite, o tratamento deve ser iniciado de imediato com antibioterapia de largo espectro e hipocoagulação. 8,9 A antibioterapia constitui o principal tratamento para a pileflebite, sendo necessário início empírico para as bactérias mais comuns (Bacteroides fragilis, Escherichia coli e anaeróbios), devendo-se ajustar o antibiótico de acordo com o resultado cultural. Alguns autores defendem que a duração do tratamento deve ser de 4 a 6 semanas, sendo 2 a 3 semanas de antibiótico endovenoso.…”

Gas in the Inferior Mesenteric Vein – successful non operative management of a rare complication of diverticulitis

“…Bacteroides specifically increases thrombosis through production of anticardiolipin antibodies which breakdown heparin and the presence of capsular components which accelerate fibrin cross-linking [8,9] . Regardless of bacteraemia or culture isolates, broad spectrum antibiotic therapy is recommended in the literature [10] we used intravenous piperacillin/tazobactam 4g/0.5g four times a day.…”