Pylephlebitis After Colonic Polypectomy Causing Fever and Abdominal Pain

Area of Science:

• Gastroenterology
• Infectious Diseases
• Vascular Surgery

Background:

• Pylephlebitis is a rare but serious condition characterized by septic thrombophlebitis of the portal venous system.
• It carries a high mortality rate if not diagnosed and treated promptly.
• Common symptoms include fever and abdominal pain, often associated with polymicrobial bacteremia.

Observation:

• An elderly woman presented with fever, abdominal pain, diarrhea, and vomiting six weeks post-polypectomy.
• Abdominal CT scan revealed a thrombus in the portal vein.
• Blood cultures identified Streptococcus milleri and Haemophilus parainfluenza type V.

Findings:

• The patient's presentation was consistent with pylephlebitis, likely secondary to the prior endoscopic procedure.
• The identified pathogens, Streptococcus milleri and Haemophilus parainfluenza type V, are implicated in the septic thrombophlebitis.
• The presence of portal vein thrombus confirmed the diagnosis.

Implications:

• Pylephlebitis should be suspected in patients with infectious symptoms following endoscopic procedures, especially those with hypercoagulable states.
• Prompt diagnosis and appropriate antibiotic therapy are essential for improving patient outcomes.
• This case highlights the importance of considering rare complications after common gastrointestinal interventions.