Pylephlebitis: a Review of 95 Cases

Area of Science:

• Medical Science
• Gastroenterology
• Infectious Diseases

Background:

• Pylephlebitis, or suppurative thrombophlebitis of the portal mesenteric venous system, is a rare but life-threatening complication of intra-abdominal inflammatory processes.
• While commonly associated with diverticulitis, its presentation can be linked to various abdominal conditions.

Purpose of the Study:

• To review the institutional experience in managing patients diagnosed with pylephlebitis.
• To identify common causes, clinical characteristics, and treatment outcomes for this rare condition.

Main Methods:

• A retrospective review of medical records from 2002 to 2012 was conducted.
• Patients with portal mesenteric vein thrombosis (PMVT) within 30 days of an intra-abdominal inflammatory process were identified and analyzed.

Main Results:

• Ninety-five patients were included, with a mean age of 57 years.
• Pancreatitis (31%) was the most common associated condition, followed by diverticulitis (19%).
• Bacteremia occurred in 44% of patients, with Streptococcus viridans being the most frequent organism. Antibiotic and anticoagulation therapy were administered in 91% and 82% of cases, respectively, with an overall mortality rate of 11%.

Conclusions:

• Pylephlebitis, though rare, most frequently presents in the context of pancreatitis.
• Individualized treatment based on culture results and thrombosis extent is crucial.
• Early diagnosis and appropriate management can lead to favorable patient outcomes.