Pylephlebitis: An infrequently recognized complication of intra-abdominal infection in the absence of detectable pathogens

Abstract

Pylephlebitis, also known as infective suppurative thrombosis of the portal vein, is a rare complication of intra-abdominal infections.  Although pylephlebitis has been increasingly recognized due to advancement in imaging studies, it still carries a high mortality rate despite early identification and adequate treatment.  In this case report, we describe a case of a 60-year-old man who presented with a two-week-history of general malaise, anorexia, fever and right-sided abdominal pain.  Imaging studies revealed acute portal vein thrombosis associated to multiple non-enhancing liver lesions compatible with liver abscesses.  The infection that lead to this dreaded complication was not identified at the time of presentation. Although liver abscesses resolved after six weeks of appropriate antibiotic treatment, portal vein thrombosis remained.