Pylephlebitis
Updates to Article Attributes
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 thisthe portal venous system
Clinical Presentation
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.
Pathology
Thrombosis of the portal circulation rapidly leads to bowel ischemia, necrosis and perforation.
Aetiology
- septic focus
:-
diverticulitis
,is the most common cause - appendicitis
- necrotising pancreatitis
-
diverticulitis
- hypercoagulative status
- trauma
- abdominal surgery
- hepatobiliary diseases: cirrhosis, hepatocellular carcinoma
,pancreatitis
Radiographic Features
Ultrasound
Findings on colour duplex sonography include flow defect and dilation or absent compressibility of the portal venous system 3.
Computed Tomography
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.
-<p><strong>Pylephlebitis</strong>, also known as <strong>ascending septic thrombophlebitis</strong>, is a thrombotic occlusion of the <a href="/articles/portal-vein">portal vein</a> or its branches secondary to infection in regions that drain to this venous system.</p><h4>Pathology</h4><h5>Aetiology</h5><ul>-<li>septic focus: <a href="/articles/diverticulitis">diverticulitis</a>, <a href="/articles/appendicitis">appendicitis</a>- +<p><strong>Pylephlebitis</strong>, also known as <strong>ascending septic thrombophlebitis</strong>, is a thrombotic occlusion of the <a href="/articles/portal-vein">portal vein</a> or its branches secondary to infection in regions that drain to the portal venous system</p><h4>Clinical Presentation</h4><p>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. </p><h4>Pathology</h4><p>Thrombosis of the portal circulation rapidly leads to bowel ischemia, necrosis and perforation. </p><h5>Aetiology</h5><ul>
- +<li>septic focus<ul>
- +<li>
- +<a href="/articles/diverticulitis">diverticulitis</a> is the most common cause</li>
- +<li><a href="/articles/appendicitis">appendicitis</a></li>
- +<li><a href="/articles/necrotising-pancreatitis">necrotising pancreatitis</a></li>
- +</ul>
-<li>hepatobiliary diseases: <a href="/articles/cirrhosis">cirrhosis</a>, <a title="Hepatocellular carcinoma" href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma</a>, <a title="Pancreatitis" href="/articles/pancreatitis">pancreatitis</a>- +<li>hepatobiliary diseases: <a href="/articles/cirrhosis">cirrhosis</a>, <a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma</a>
-</ul>- +</ul><h4>Radiographic Features</h4><h5>Ultrasound</h5><p>Findings on colour duplex sonography include flow defect and dilation or absent compressibility of the portal venous system <sup>3</sup>.</p><h5>Computed Tomography</h5><p>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 <sup>3</sup>.</p><h4>Treatment and prognosis</h4><p>Medical management with antibiotics and anticoagulation is the mainstay of therapy. </p><p>Mortality with early treatment remains as high as 25% <sup>2</sup>.</p><h4>History and Etymology</h4><p><strong>Pylephlebitis</strong> was initially described by Waller in 1954 as a cause of hepatic abscess found during autopsy<sup> 1</sup>.</p>
References changed:
- 1. Hoffman H, Partington P, Desanctis A. Pylephlebitis and Liver Abscess. Am J Surg. 1954;88(3):411-6. <a href="https://doi.org/10.1016/0002-9610(54)90358-x">doi:10.1016/0002-9610(54)90358-x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/13189007">Pubmed</a>
- 2. Korelitz B & Sommers S. Responses to Drug Therapy in Ulcerative Colitis. Evaluation by Rectal Biopsy and Mucosal Cell Counts. Am J Dig Dis. 1976;21(6):441-7. <a href="https://doi.org/10.1007/BF01072126">doi:10.1007/BF01072126</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8981">Pubmed</a>
- 3. Choudhry A, Baghdadi Y, Amr M, Alzghari M, Jenkins D, Zielinski M. Pylephlebitis: A Review of 95 Cases. J Gastrointest Surg. 2016;20(3):656-61. <a href="https://doi.org/10.1007/s11605-015-2875-3">doi:10.1007/s11605-015-2875-3</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26160320">Pubmed</a>
Image 2 CT (C+ portal venous phase) ( create )
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