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Pylephlebitis associated with acute infected choledocholithiasis

Yu-Tzu Tsao1, Shih-Hua Lin2, Chih-Jen Cheng2

  • 1Division of Gastroenterology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.

The American Journal of the Medical Sciences
|August 16, 2006
PubMed

Insights

Pylephlebitis, a rare but fatal portal vein infection, was successfully treated in a patient with infected bile duct stones. Prompt diagnosis and treatment led to complete recovery and portal vein recanalization.

Area of Science:

  • Gastroenterology and Hepatology
  • Infectious Diseases
  • Vascular Surgery

Background:

  • Pylephlebitis, or septic thrombophlebitis of the portal vein, is a rare intra-abdominal infection with high mortality.
  • It is often underdiagnosed due to its infrequent occurrence and non-specific symptoms.

Observation:

  • A 66-year-old male presented with acute infected choledocholithiasis and Bacteroides fragilis bacteremia.
  • Contrast-enhanced CT revealed near-total thrombotic occlusion of the left portal vein.
  • Hypercoagulation disorder tests were negative.

Findings:

  • Endoscopic extraction of bile duct stones and broad-spectrum antibiotics resulted in patient recovery.
  • Complete recanalization of the previously occluded portal vein was observed.
  • This case represents the first reported instance of pylephlebitis associated with acute infected choledocholithiasis.

Implications:

  • Early identification of pylephlebitis through advanced imaging and clinical awareness is crucial.
  • Prompt eradication of infectious foci and appropriate antimicrobial therapy are essential for reducing morbidity and mortality.
  • This case highlights the importance of considering pylephlebitis in patients with intra-abdominal infections and biliary pathology.

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