SHM Converge Scientific Abstract ePoster Gallery-Pylephlebitis, a Deadly Complication of a Common Hospital Diagnosis

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This case report describes a 56-year-old man with hypertension, recurrent UTIs, and diverticulitis who presented with 4 days of fever, chills, malaise, dizziness, and worsening shortness of breath. He was found to have severe sepsis from acute diverticulitis with lactic acidosis, acute kidney injury, leukocytosis, hyperbilirubinemia, and transaminitis. Blood cultures grew <em>E. coli</em>, and GI panel testing detected <em>E. coli</em> and <em>Bacteroides fragilis</em>. Initial CT imaging showed diverticulitis with portal venous gas.

Despite broad-spectrum antibiotics, he clinically worsened, developing persistent leukocytosis, rising bilirubin, and jaundice. Further imaging with MRCP and repeat CT demonstrated extensive mesenteric venous thrombosis and inflammatory changes consistent with pylephlebitis, without abscess or perforation. Surgery, gastroenterology, and infectious disease teams recommended continued conservative management.

He was treated with 4 weeks of IV ertapenem and started on anticoagulation with warfarin bridged by enoxaparin. Weekly laboratory monitoring and follow-up colonoscopy after recovery were planned.

The discussion highlights that pylephlebitis is a rare but deadly infective thrombophlebitis of the portal venous system, usually arising from abdominal or pelvic infections such as diverticulitis or appendicitis. Common organisms include <em>E. coli</em>, <em>Bacteroides</em> species, and streptococci. Although uncommon, it carries significant mortality and can progress to abdominal infarction if untreated. Repeat imaging is important when patients worsen despite antibiotics, as early imaging may miss evolving thrombosis. Broad-spectrum antibiotics are essential, and anticoagulation may be considered when thrombosis progresses or fevers persist despite therapy.

Asset Subtitle

Rani Y. Shah

Meta Tag

Author List Joseph Crispino, Kevin d'Mello, Rani Y. Shah, Ravneet Boparai

Category Clinical Vignettes

Concept Pylephlebitis

Concept Diverticulitis

Concept Broad-Spectrum Antibiotic

Concept Portal Venous System

Concept Intra-abdominal Sepsis

Distinguished Non-Finalist

Presenter Organization Inspira Health

Presenting Author Rani Y. Shah

Track Adult

Keywords

pylephlebitis

diverticulitis

sepsis

portal venous gas

mesenteric venous thrombosis

E. coli bacteremia

Bacteroides fragilis

acute kidney injury

antibiotic therapy

anticoagulation

Pylephlebitis

Diverticulitis

Broad-Spectrum Antibiotic

Portal Venous System

Intra-abdominal Sepsis