SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Pylephlebitis

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This case report describes a 70-year-old man who presented with 10 days of fever, chills, sweating, right lower quadrant abdominal pain, nausea, vomiting, poor appetite, weakness, and marked weight loss. On exam, he appeared ill, was mildly febrile and tachycardic, and had mild tenderness in the right upper and lower abdomen.<br /><br />Laboratory testing showed leukocytosis (20,000), elevated ESR and CRP, hyponatremia, and mildly abnormal liver tests with a cholestatic pattern. CT abdomen/pelvis with IV contrast demonstrated left portal vein thrombosis consistent with pylephlebitis, along with colonic diverticulosis but no clear diverticulitis.<br /><br />He was started empirically on meropenem and enoxaparin. Blood cultures later grew beta-hemolytic Group C Streptococcus in both aerobic and anaerobic bottles. A transthoracic echocardiogram ruled out infective endocarditis. The patient improved clinically and was discharged on six weeks of oral moxifloxacin; anticoagulation was stopped before discharge.<br /><br />The report emphasizes that pylephlebitis, or suppurative thrombophlebitis, is a rare but serious complication of intra-abdominal or pelvic infections, most often related to diverticulitis or appendicitis. Typical symptoms include fever, fatigue, and abdominal pain, while CT imaging is the preferred diagnostic test because it can identify both portal vein thrombosis and the underlying infectious source. Complications can include thrombus extension, hepatic abscess, splenic or hepatic infarction, chronic thrombosis, and death. Treatment generally consists of antibiotics, with anticoagulation sometimes used but still considered controversial.

Asset Subtitle

Aakriti Mainali

Meta Tag

Author List Aakriti Mainali, Agya Mainali

Category Clinical Vignettes

Concept Pylephlebitis

Concept Portal Vein Thrombosis

Concept Computed Tomography

Concept Broad-Spectrum Antibiotic

Concept Portal Venous System

Distinguished Non-Finalist

Presenter Organization Bassett Medical Center

Presenting Author Aakriti Mainali

Track Adult

Keywords

pylephlebitis

portal vein thrombosis

Group C Streptococcus

diverticulosis

abdominal pain

fever

CT imaging

meropenem

anticoagulation

intra-abdominal infection

Pylephlebitis

Portal Vein Thrombosis

Computed Tomography

Broad-Spectrum Antibiotic

Portal Venous System