Pylephlebitis, also known as ascending septic thrombophlebitis, is a thrombotic occlusion of the portal vein or its branches secondary to infection in regions that drain to the portal venous system.
Clinical presentation is often vague. Patients may initially present with non-specific abdominal pain, nausea and sepsis in the context of an intra-abdominal infection. Sequelae from hepatic involvement such as jaundice or hepatomegaly may occur in advanced stages.
Thrombosis of the portal circulation rapidly leads to bowel ischemia, necrosis and perforation.
- septic focus
- hypercoagulative status
- abdominal surgery
- hepatobiliary diseases: cirrhosis, hepatocellular carcinoma
Findings on color duplex sonography include flow defect and dilation or absent compressibility of the portal venous system 3.
CT is the modality of choice as it may also detect an underlying cause as well as complications such as bowel ischemia or abscess formation. The finding of an endoluminal thrombus causing a filling defect in contrast filled mesenteric veins is diagnostic 3.
Treatment and prognosis
Medical management with antibiotics and anticoagulation is the mainstay of therapy.
Mortality with early treatment remains as high as 25% 2.
History and Etymology
Pylephlebitis was initially described by Waller in 1954 as a cause of hepatic abscess found during autopsy 1.
- 1. Hoffman HL, Partington PF, Descantis AL. Pylephlebitis and liver abscess. (1954) American journal of surgery. 88 (3): 411-6. Pubmed
- 2. Korelitz BI, Sommers SC. Responses to drug therapy in ulcerative colitis. Evaluation by rectal biopsy and histopathological changes. (1975) The American journal of gastroenterology. 64 (5): 365-70. Pubmed
- 3. Choudhry AJ, Baghdadi YM, Amr MA, Alzghari MJ, Jenkins DH, Zielinski MD. Pylephlebitis: a Review of 95 Cases. (2016) Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 20 (3): 656-61. doi:10.1007/s11605-015-2875-3 - Pubmed