Pylephlebitis: Report of a Case Secondary to Appendicitis and Review of Cases Reported in Korea

Mee Won Hwang; Baek-Nam Kim

doi:10.3947/ic.2010.42.3.203

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Hwang and Kim: Pylephlebitis: Report of a Case Secondary to Appendicitis and Review of Cases Reported in Korea

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(3): 203-207.

Published online: 30 June 2010

DOI: https://doi.org/10.3947/ic.2010.42.3.203

Pylephlebitis: Report of a Case Secondary to Appendicitis and Review of Cases Reported in Korea

Mee Won Hwang, Baek-Nam Kim

Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea.

Corresponding author: Baek-Nam Kim, M.D. Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Nowon-gu, Seoul 139-707, Korea. Tel: +82-2-950-8863, Fax: +82-2-950-1955, kimbn@paik.ac.kr

Received 4 February 2010 Revised 23 April 2010 Accepted 23 April 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pylephlebitis occurs secondary to infection in the region drained by the portal venous system. We described a case of pylephlebitis which developed as a complication of appendicitis and reviewed 22 cases of pylephlebitis, including the current case, reported in Korea. Appendicitis, followed by diverticulitis, was the most common infection associated with pylephlebitis. Fever and abdominal pain were the most common presenting symptoms. Bacteremia was present in 60% of cases. Streptococci, enteric gram-negative bacilli, and Bacteroides fragilis were common organisms isolated from the blood. Liver abscess was identified in 3 cases. All patients survived regardless of anticoagulation therapy. Although pylephlebitis is a rare disease, it should be included in the differential diagnosis in patients with fever of unknown origin who present with nonspecific abdominal symptoms or abnormal liver function test.

Keywords: Thrombophlebitis, Portal vein, Mesenteric veins, Appendicitis, Diverticulitis

Figures and Tables

Figure 1

Enhanced computed tomography of abdomen and pelvis shows (A) thrombosis of left portal vein (arrow) and (B) a thrombus in the lumen of the superior mesenteric vein (arrow) on venous phase.

Table 1

Summary of 22 Cases of Pylephlebitis Reported in Korea

AG, aminoglycoside; ALC, alcoholic liver cirrhosis; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BIL, total bilirubin; BPH, benign prostate hypertrophy; d, day; DM, diabetes mellitus; HTN, hypertension; IC, intracatheter administration; I & D, incision and drainage; IMV, inferior mesenteric vein; LMWH, low molecular weight heparin; LPV, left portal vein; MPV, main portal vein; mo, month; PV, portal vein; RPV, right portal vein; SMV, superior mesenteric vein; s/p, status post; TGC, third-generation cephalosporin; wk, week

Table 2

Comparison of Korean and Other Cases

^*Polymicrobial culture results have been excluded since the species were not stated.

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