Pylephlebitis associated with acute infected choledocholithiasis.
Pylephlebitis, also called septic thrombophlebitis of the portal vein, is a life-threatening complication of intra-abdominal infection. Although rare, it remains a less recognized entity with a high rate of mortality. We present a 66-year-old man with acute infected choledocholithiasis complicated with Bacteroides fragilis bacteremia. The contrast-enhanced computed tomography scan of the abdomen showed nearly total thrombotic occlusion of the left portal vein. The comprehensive studies for hypercoagulation disorders all yielded negative results. After endoscopic extraction of bile duct stones and broad-spectrum antibiotic therapy, the patient recuperated with complete recanalization of the occluded portal vein. To our knowledge, pylephlebitis associated with acute infected choledocholithiasis has never been reported. This report details the clinical features, radiographic findings, pathogenesis, and treatment of this distinctly unusual manifestation. Early identification of pylephlebitis and underlying intra-abdominal infection can be achieved by exquisite imaging studies with raised awareness in the clinical setting. Eradication of infectious foci and judicious administration of antimicrobials are essential to reduce the catastrophic morbidity and mortality of pylephlebitis.
Tsao
Yu-Tzu
YT
Division of Gastroenterology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Lin
Shih-Hua
SH
The Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Cheng
Chih-Jen
CJ
The Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Chang
Feng-Yee
FY
Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.. Electronic address: fychang@ndmctsgh.edu.tw.
D034841:Abdominal Cavity / Q000000981:diagnostic imaging / Q000382:microbiology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D001442:Bacteroides Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D001441:Bacteroides fragilis; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy; D006801:Humans; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000382:microbiology; D012074:Remission Induction; D013924:Thrombophlebitis / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000379:methods
D000900:Anti-Bacterial Agents