Pylephlebitis: A Rare but Redoubtable Complication of Intra-Abdominal Infections-A Series of 15 Cases

Area of Science:

• Infectious Diseases
• Internal Medicine
• Radiology

Background:

• Pylephlebitis, defined as suppurative thrombosis of the portal vein system, is an infrequent yet severe intra-abdominal infection.
• Historically associated with complications from diverticulitis or appendicitis, it is predominantly reported in surgical literature.

Purpose of the Study:

• To evaluate the efficacy and role of managing pylephlebitis within an infectious disease clinical setting.
• To analyze the clinical characteristics, radiological findings, and treatment outcomes of pylephlebitis patients managed by infectious disease specialists.

Main Methods:

• Retrospective review of medical records from 2001 to 2024 at a tertiary infectious diseases hospital.
• Inclusion criteria focused on patients diagnosed with pylephlebitis, with data extraction on demographics, clinical presentation, radiological findings, microbiological data, and treatment regimens.
• Analysis of treatment outcomes, including mortality and need for surgical intervention.

Main Results:

• Fifteen cases of pylephlebitis were identified, with a median age of 58 years and a male predominance (4:1 ratio).
• Portal vein thrombosis (PVT) accompanied by liver abscesses was the predominant radiological finding (80% of cases).
• Gram-negative aerobic bacteria were the most common isolates (5/8 positive blood cultures), with polymicrobial infections occurring in half of cases. Prompt broad-spectrum antibiotic therapy and anticoagulation were administered to most patients.

Conclusions:

• An infectious disease setting is crucial for the effective management of pylephlebitis.
• Early diagnosis and aggressive treatment with broad-spectrum antibiotics and anticoagulation are vital for improving patient outcomes.
• Liver abscesses are common sequelae, emphasizing the need for comprehensive management strategies.