Pylephlebitis: An overview of non-cirrhotic cases and factors related to outcome

Abstract

Pylephlebitis is a condition with significant morbidity and mortality. We review herein 100 relevant case reports published since 1971. Eighty-one patients were reported with acute pylephlebitis, while the remaining patients had chronic pylephlebitis. The most common predisposing infections leading to pylephlebitis were diverticulitis and appendicitis. Cultures from blood or other tissues were positive in 77%. The infection was polymicrobial in half of the patients and the most common isolates were Bacteroides spp, Escherichia coli and Streptococcus spp. Thrombosis was extended to the superior mesenteric vein (SMV), splenic vein, and intrahepatic branches of the portal vein (PV) in 42%, 12%, and 39%, respectively. Antibiotics were administered in all and anticoagulation in 35 cases. Patients who received anticoagulation had a favourable outcome compared to those who received antibiotics alone (complete recanalization 25.7% vs 14.8% (p > 0.05), no recanalization 5.7% vs 22.2% (p < 0.05), and death 5.7% vs 22.2% (p < 0.01)). Cases with complete recanalization had prompt diagnosis and management and two-thirds were recently published. Nineteen patients died; the majority of these (73.7%) died over the period 1971-1990. In conclusion, pylephlebitis remains an entity with high morbidity and mortality, but modern imaging modalities have facilitated an earlier diagnosis and have improved the prognosis. Anticoagulation has a rather beneficial effect on patients with pylephlebitis.

Bacteroides-Associated Pylephlebitis in a Patient with Strongyloidiasis

“…E-mail: neil.stone@nhs.net secondary to diverticulitis; however, it has been reported with appendicitis and cholecystitis. 7 It is nearly always associated with bacteremia, which is often polymicrobial, and B. fragilis, which was isolated in our patient, is the single most commonly isolated organism. 4 This is postulated to be secondary to the induction of procoagulant macrophage activity by B. fragilis.…”

Acute Infective Portal Vein Thrombosis Secondary to Acute Sigmoid Diverticulitis

“…Concomitant anticoagulation is subject to debate. In a recent study by Kanellopoulou et al patients treated with anticoagulation in addition to standard antibiotic therapy showed better outcome [9] . Previous studies reported benefit limited only to patients with thrombosis extending beyond the portal vein [13] , or lack of outcome differences all together [1] .…”

“…It is important to note that up to 60% of patients may have no or minimal clinical features secondary to the primary cause at time of evaluation [6] . Typical associated risk factors include diverticulitis (30%, mostly sigmoid), appendicitis (19%), inflammatory bowel disease (6%), pancreatitis (5%), infectious enteritis (4%), and recent abdominal surgeries [3,[7][8][9] . Although diverticulitis is the most common cause of pylephlebitis, pylephlebitis is a rare complication of diverticulitis (3%).…”

“…Based on the most recent evidence, anticoagulation for 3-6 months should be considered to prevent extension of thrombosis and favor recanalization (reported in up to 92.6% of patients) [8] . Treatment delay may result in various complications including thrombosis extension, septic emboli with hepatic abscess formation, bowel ischemia, and portal hypertension [5,9,14] . Death typically results from sepsis, peritonitis, intestinal bleeding, or portal vein rupture [3] .…”

A Case of liver abscess with Portal Vein Thrombosis caused by α-Hemolytic streptococci

“…Kanellopoulou et al [13] reported better outcomes in pylephlebitis Plessier et al [12] recommended prompt anticoagulation in patients with acute PVT of the portal vein or its left or right branches because of the high prevalence of permanent risk factors for venous thrombosis. Hall et al [14] reported that partial or complete recanalization occurred in 81.8% of patients with acute PVT and liver cirrhosis or malignancies who were treated with anticoagulants and in 37.5% of those who were not.…”