A Rare Case of Pylephlebitis as a Complication of Cholecystocolonic Fistula

Area of Science:

• Gastroenterology
• Vascular Surgery
• Infectious Diseases

Background:

• Pylephlebitis is a serious condition involving septic thrombophlebitis of the portal vein and its tributaries, often stemming from intra-abdominal infections.
• Cholecystocolonic fistula (CCF) is an uncommon pathological connection between the gallbladder and colon, potentially leading to severe complications.

Observation:

• A 41-year-old male presented with persistent upper abdominal pain and anorexia, indicative of a serious underlying condition.
• Contrast-enhanced computed tomography (CT) revealed portal vein thrombosis (PVT), specifically in the left and anterior branches, alongside thickened portal vein walls.
• Additional findings included a collapsed gallbladder and pneumobilia, suggesting biliary tract involvement, and blood cultures identified *Streptococcus anginosus*.

Findings:

• The patient was diagnosed with pylephlebitis associated with a cholecystocolonic fistula.
• Initial management involved intravenous broad-spectrum antibiotics and anticoagulation to address the septic thrombosis.
• Surgical intervention, including cholecystectomy and partial colectomy, was performed after the acute phase of PVT and inflammation resolved.

Implications:

• This case underscores the critical importance of maintaining a high index of suspicion for pylephlebitis in patients with intra-abdominal infections.
• Prompt diagnosis via CT imaging is crucial for initiating timely and appropriate treatment, potentially improving patient outcomes.
• The successful management highlights the necessity of a combined medical and surgical approach for complex cases involving pylephlebitis and fistulous connections.