Pylephlebitis: A Rare but Redoubtable Complication of Intra-Abdominal Infections—A Series of 15 Cases
Abstract
1. Introduction
1.1. Definition
1.2. Pathophysiology
1.2.1. PVT
- The hypercoagulable status is the primary determinant of PVT in patients with inherited or acquired thrombophilia. An example of acquired thrombophilia is primary myeloproliferative disorders. Another group of conditions associated with hypercoagulable status includes neoplastic diseases. In some cases, direct invasion of the portal vein (such as in hepatocellular carcinoma and cholangiocarcinoma), or tumour or lymph node compression, may favour PVT [8].
- Slowed portal blood flow. Reduced portal venous flow is a key contributor to portal vein thrombosis (PVT) in patients with liver cirrhosis, primarily due to structural distortion of the hepatic architecture. Moreover, cirrhotic patients exhibit a distinct haemostatic profile known as rebalanced haemostasis, which renders them susceptible to both bleeding and thrombotic complications [8,9]. Additionally, endotoxemia—frequently observed in cirrhosis—is associated with an increased risk of thrombotic events [8].
- Endothelial (vascular) injury. Intra-abdominal inflammatory or infectious diseases, as well as local injuries related to surgical procedures, can damage the vascular endothelium [10,11,12]. Activated neutrophils in inflamed areas promote thrombin generation and thrombi formation, a phenomenon observed regardless the cirrhotic or non-cirrhotic status [13,14,15].
1.2.2. Pylephlebitis
1.3. Aetiology and Diagnosis
1.4. Evolution and Prognosis
1.5. The Aim of Our Study
2. Materials and Methods
3. Results
3.1. Demographics and Risk Factors
- Out of 15 patients, 12 were men, with a male-to-female ratio of 4:1. The age at diagnosis had a median of 58 years [IQR: 28].
- The comorbidities of each patient were listed in Table 1. As PVT known risk factors, five patients reported alcohol abuse, one had thrombophilia (without being on anticoagulation treatment), one had an antiphospholipid syndrome, and one was diagnosed during admission with a pancreatic head tumour. The team carefully reviewed this case. It was finally included in the study as it was a small mass, localised in the pancreatic head, without local involvement of the lymph nodes, or criteria for local invasion (particularly in the local veins), and it was associated with a liver abscess.
3.2. Diagnosis
3.2.1. Clinical Features
3.2.2. Laboratory Nonspecific Tests
3.2.3. Microbiology
3.2.4. Imaging
3.3. Treatment
3.3.1. Antibiotic Therapy
3.3.2. Anticoagulant Therapy
3.3.3. Surgery
3.4. Outcome
4. Discussion
4.1. Infectious Source of Pylephlebitis
4.2. Clinical Presentation in Pylephlebitis
4.3. Paraclinical Findings in Pylephlebitis
4.3.1. Routine Laboratory Tests
4.3.2. Etiological Agent(s)
4.3.3. Imaging in Pylephlebitis
4.4. Treatment of Pylephlebitis
4.4.1. Antibiotics
4.4.2. Anticoagulant and Recanalization (Thrombolytic) Treatment
4.4.3. Surgery in Pylephlebitis
4.5. Evolution, Complications, and Prognosis
4.6. The Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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No. | Sex Age | Comorbidities | Clinical | Intra- Abdominal Infection | Imagery (US/CT) | Blood Cultures |
---|---|---|---|---|---|---|
#1 | M 24 | HIV infection History of tuberculosis | Fever Sepsis Jaundice Profuse sweating Deterioration of general condition Weight loss | Undetermined | (CT): PVT Hepatosplenomegaly Multiple intra-abdominal enlarged lymph nodes | Negative |
#2 | M 66 | Diabetes Alcohol abuse | Fever and chills Abdominal pain (epigastric) Myalgia and arthralgia Loss of appetite Physical asthenia | Liver abscess (multiple) | (US): Left branch PVT Multiple liver abscesses | Negative |
#3 | M 44 | Burns of 2/3 degree | Fever | Liver abscess (multiple) | (CT): Multiple liver abscesses | Negative |
#4 | M 60 | Diabetes | Low-grade fever and chills Diarrhoea Confusion Physical asthenia | Liver abscess (two) | (US): Main PVT (CT): Two liver abscesses Pancreatic head tumour without local invasion | Klebsiella pneumoniae Escherichia coli |
#5 | M 67 | Cardiac pathology Aortic prosthesis History of Pyocholecystitis and liver abscesses | Fever | Cholecystitis Liver abscess (multiple) | (CT): Right branch PVT Multiple hepatic abscesses Cholecystitis (US): Portal vein gas Multiple hepatic abscesses | Negative |
#6 | F 58 | Cardiac pathology Diabetes Alcohol abuse | Fever and chills Abdominal pain (intermittent, right hypochondrium) Nausea and vomiting | Liver abscess (not detailed) | (CT): PVT; Suprahepatic vein thrombosis Hepatic abscess | Klebsiella pneumoniae |
#7 | M 48 | Cardiac pathology COPD Obesity Diverticulosis | Fever Abdominal pain (colicky, diffuse) | Diverticulitis Intraabdominal abscess (not detailed) | (CT): Main PVT Portal vein gas Diverticulitis with secondary abscess | Klebsiella pneumoniae Enterococcus avium |
#8 | M 75 | Cardiac pathology Ictus Alcohol abuse | Fever | Splenic abscess Liver abscess (multiple) | (CT): Right branch PVT Hepatic and splenic abscesses | Negative |
#9 | F 64 | Hypertension Diabetes Recent history of Pyocholecystitis | Fever | Cholecystitis Liver abscess (not detailed) | (CT): PVT Hepatosplenomegaly Hepatic abscess Cholecystitis | Negative |
#10 | M 83 | Dementia Alcohol abuse | Fever and chills Abdominal pain (diffuse) Loss of appetite Loss of consciousness | Splenic abscess Prostatic abscess Liver abscess (multiloculated) | (CT): Left branch PVT Multiloculated hepatic abscess Splenic abscesses Prostatic abscess | Bacteroides fragilis |
#11 | M 16 | No comorbidities | Fever Abdominal pain Dry cough Loss of appetite Deterioration of general condition | Splenic abscess Liver abscess (multiple) | (CT): PVT Multiple hepatic abscesses Dilatation of intrahepatic bile ducts (US): Multiple hepatic abscesses Multiple splenic abscesses | Bacteroides fragilis Clostridium symbiosum |
#12 | M 51 | Hypertrophic cardiomyopathy | Fever Nausea Myalgia | Liver abscess (not detailed) | (CT): Main PVT; Suprahepatic vein thrombosis Hepatic abscess | Klebsiella pneumoniae Pseudomonas aeruginosa |
#13 | M 39 | Alcohol abuse | Fever and chills Nausea Weight loss Abdominal pain (epigastric and right hypochondrium) | Liver abscess (multiple) | (CT): Main PVT; Porto-splenic confluence thrombosis Hepatosplenomegaly Multiple hepatic abscesses | Negative |
#14 | F 74 | Cardiac pathology Antiphospholipid syndrome Diverticulosis | Fever Abdominal pain (diffuse) Diarrhoea | Liver abscess (not detailed) | (CT): PVT Hepatic abscess | Escherichia coli |
#15 | M 38 | Thrombophilia HIV newly Dx Obesity | Fever; chills Abdominal pain (epigastric and right hypochondrium) Nausea; vomiting Diarrhoea | Diverticulitis Pancreatitis | (CT): Total PVT; Splenic and Superior Mesenteric veins thrombosis; Right branch PVT Portal cavernoma (left portal branch transformation) Splenic infarction | Bacteroides fragilis |
No | Sex Age | Antibiotic Therapy | ATB Duration (Days) | Anti Coagulation | Surgery | Outcome |
---|---|---|---|---|---|---|
#1 | M, 24 | Meropenem (20 days) | 20 | No | No | Death |
#2 | M, 66 | Ciprofloxacin (7 days) → Levofloxacin + Ampicillin/Sulbactam (23 days) | 30 | LMWH | No | Favourable |
#3 | M, 44 | Meropenem + Linezolid + Colistin (23 days) → Meropenem + Linezolid + Fluconazole (14 days) → Linezolid + Tigecycline (1 day) → Tigecycline (24 days) | 62 | LMWH VKA | No | Favourable |
#4 | M, 60 | Tigecycline + Ceftazidime (25 days) → Tigecycline (10 days) → Moxifloxacin + Ceftazidime (6 days) | 41 | LMWH | No | Death |
#5 | M, 67 | Piperacillin/Tazobactam + Gentamicin (14 days) → Piperacillin/Tazobactam (37 days) | 51 | VKA (started before diagnosis) | No | Favourable Fibrosis in the affected territory |
#6 | F, 58 | Ampicillin/Sulbactam (5 days) → Piperacillin/Tazobactam (2 days) → Ertapenem + Teicoplanin (11 days) | 42 | LMWH | Yes (liver abscess drainage) | Unknown |
#7 | M, 48 | Tigecycline + Meropenem + Linezolid + Colistin (21 days) → Tigecycline + Meropenem + Colistin (21 days) | 18 | LMWH VKA | Yes (drainage of intra-abdominal abscess) | Favourable |
#8 | M, 75 | Meropenem + Vancomycin (14 days) | 14 | LMWH | No | Favourable |
#9 | F, 64 | Meropenem + Vancomycin (5 days) → Meropenem (21 days) | 26 | LMWH | Yes (Cholecystectomy) | Favourable |
#10 | M, 83 | Ertapenem (25 days) → Tigecycline (9 days) → Ceftriaxone + Metronidazole (7 days) → Metronidazole (7 days) | 23 | LMWH | No | Favourable |
#11 | M, 16 | Ceftriaxone (2 days) → Cefotaxime (6 days) → Ciprofloxacin + Sulfamethoxazole/Trimethoprim (5 days) → Piperacillin/Tazobactam + Metronidazole (25 days) → Piperacillin/Tazobactam (8 days) | 46 | LMWH | No | Favourable Hepatic left lobe atrophy |
#12 | M, 51 | Cefotaxime + Metronidazole (9 days) → Cefixime + Metronidazole (7 days) → Meropenem (22 days) | 38 | LMWH | No | Favourable |
#13 | M, 39 | Piperacillin/Tazobactam (29 days) | 29 | LMWH | No | Favourable |
#14 | F, 74 | Ampicillin/Sulbactam (7 days) → Ampicillin/Sulbactam (4 days) → Ertapenem (1 day) | 12 | VKA | Yes (drainage of hepatic abscess) | Unknown |
#15 | M, 38 | Piperacillin/Tazobactam (6 days) → Metronidazole (10 days) | 16 | LMWH DOAC | No | Favourable Portal (hepatic hilus) cavernoma |
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Benea, S.N.; Deaconu, T.; Florea, D.; Moroti, R.; Oprica, G.; Nae, A.; Patrascu, R.E.; Militaru, E.; Gedik, H.; Savulescu-Fiedler, I. Pylephlebitis: A Rare but Redoubtable Complication of Intra-Abdominal Infections—A Series of 15 Cases. Life 2025, 15, 1525. https://doi.org/10.3390/life15101525
Benea SN, Deaconu T, Florea D, Moroti R, Oprica G, Nae A, Patrascu RE, Militaru E, Gedik H, Savulescu-Fiedler I. Pylephlebitis: A Rare but Redoubtable Complication of Intra-Abdominal Infections—A Series of 15 Cases. Life. 2025; 15(10):1525. https://doi.org/10.3390/life15101525
Chicago/Turabian StyleBenea, Serban Nicolae, Teodora Deaconu, Dragos Florea, Ruxandra Moroti, Gabriela Oprica, Alina Nae, Raluca Elena Patrascu, Eliza Militaru, Habip Gedik, and Ilinca Savulescu-Fiedler. 2025. "Pylephlebitis: A Rare but Redoubtable Complication of Intra-Abdominal Infections—A Series of 15 Cases" Life 15, no. 10: 1525. https://doi.org/10.3390/life15101525
APA StyleBenea, S. N., Deaconu, T., Florea, D., Moroti, R., Oprica, G., Nae, A., Patrascu, R. E., Militaru, E., Gedik, H., & Savulescu-Fiedler, I. (2025). Pylephlebitis: A Rare but Redoubtable Complication of Intra-Abdominal Infections—A Series of 15 Cases. Life, 15(10), 1525. https://doi.org/10.3390/life15101525