Percutaneous diagnosis and drainage of pylephlebitis: a case report

Suppurative pylephlebitis is a rare complication of intra-abdominal inflammatory processes, but it carries a high mortality rate. Even in this modern era, diagnosis and treatment are difficult because of the nonspecificity of clinical signs and symptoms, as well as laboratory tests. We present a case in which the diagnosis of pylephlebitis was made in the radiology department by percutaneous needle aspiration of the portal venous system. Computerized tomography is very helpful in the diagnosis of pylephlebitis but requires that the radiologist be familiar with this rare entity. The computerized tomographic findings in this case are described and discussed. This patient was treated with percutaneous transhepatic drainage of the portal venous system and antibiotics only since we thought he would not survive a surgical procedure. To the best of our knowledge, there have been no previous reports of percutaneous therapy of pylephlebitis. The patient had an uneventful recovery.