Pylephlebitis
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- updated 19 Aug 2022:
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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 Presentationpresentation
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 ischaemia, necrosis and perforation.
Aetiology
-
septic focus
diverticulitis is the most common cause
hypercoagulative status
abdominal surgery
hepatobiliary diseases: cirrhosis, hepatocellular carcinoma
Radiographic Featuresfeatures
Ultrasound
Findings on colour duplex sonography include flow defect and dilation or absent compressibility of the portal venous system 3.
Computed TomographyCT
CT is the modality of choice as it may also detect an underlying cause as well as complications such as bowel ischaemia or abscess formation. The finding of an endoluminal thrombus causing a filling defect in contrast filled mesenteric veins is diagnostic 3.
Treatment and prognosis
Complications of pylephebitispylephlebitis include thrombus propagation into a mesenteric vein, hepatic abscess, hepatic and splenic infarctions and chronic thrombosis 4.
Medical management with antibiotics and anticoagulation is the mainstay of therapy.
Mortality with early treatment remains as high as 25% 2,4.
History and Etymologyetymology
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 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 ischaemia, necrosis and perforation. </p><h5>Aetiology</h5><ul>-<li>septic focus<ul>-<li>-<a href="/articles/colonic-diverticulitis-1">diverticulitis</a> is the most common cause</li>-<li><a href="/articles/acute-appendicitis-2">appendicitis</a></li>-<li><a href="/articles/necrotising-pancreatitis">necrotising pancreatitis</a></li>-</ul>-</li>-<li>hypercoagulative status</li>-<li>trauma</li>-<li>abdominal surgery</li>-<li>hepatobiliary diseases: <a href="/articles/cirrhosis">cirrhosis</a>, <a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma</a>-</li>-</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 ischaemia 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>Complications of pylephebitis include thrombus propagation into a mesenteric vein, hepatic abscess, hepatic and splenic infarctions and chronic thrombosis <sup>4</sup>.</p><p>Medical management with antibiotics and anticoagulation is the mainstay of therapy. </p><p>Mortality with early treatment remains as high as 25% <sup>2,4</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>- +<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 <a href="/articles/jaundice" title="Jaundice">jaundice</a> or <a href="/articles/hepatomegaly" title="Hepatomegaly">hepatomegaly</a> may occur in advanced stages. </p><h4>Pathology</h4><p>Thrombosis of the portal circulation rapidly leads to bowel ischaemia, necrosis and perforation. </p><h5>Aetiology</h5><ul>
- +<li>
- +<p>septic focus</p>
- +<ul>
- +<li><p><a href="/articles/colonic-diverticulitis-1">diverticulitis</a> is the most common cause</p></li>
- +<li><p><a href="/articles/acute-appendicitis-2">appendicitis</a></p></li>
- +<li><p><a href="/articles/necrotising-pancreatitis">necrotising pancreatitis</a></p></li>
- +</ul>
- +</li>
- +<li><p>hypercoagulative status</p></li>
- +<li><p><a href="/articles/trauma" title="Trauma">trauma</a></p></li>
- +<li><p>abdominal surgery</p></li>
- +<li><p>hepatobiliary diseases: <a href="/articles/cirrhosis">cirrhosis</a>, <a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma</a></p></li>
- +</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>CT</h5><p>CT is the modality of choice as it may also detect an underlying cause as well as complications such as bowel ischaemia 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>Complications of pylephlebitis include thrombus propagation into a mesenteric vein, hepatic abscess, hepatic and splenic infarctions and chronic thrombosis <sup>4</sup>.</p><p>Medical management with antibiotics and anticoagulation is the mainstay of therapy. </p><p>Mortality with early treatment remains as high as 25% <sup>2,4</sup>.</p><h4>History and etymology</h4><p>Pylephlebitis 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>
- 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>
- 4. Hartpence J & Woolf A. Pylephlebitis. 2023. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33085393">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>
- 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>
- 1. Hoffman HL, Partington PF, Descantis AL. Pylephlebitis and liver abscess. (1954) American journal of surgery. 88 (3): 411-6. <a href="https://www.ncbi.nlm.nih.gov/pubmed/13189007">Pubmed</a> <span class="ref_v4"></span>
- 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. <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> <span class="ref_v4"></span>
- 4. Jesse Hartpence, Andrew Woolf. Pylephlebitis. (2020) <a href="https://www.ncbi.nlm.nih.gov/pubmed/33085393">Pubmed</a> <span class="ref_v4"></span>
- 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. <a href="https://www.ncbi.nlm.nih.gov/pubmed/2008">Pubmed</a> <span class="ref_v4"></span>
- 2. Korelitz B & Sommers S. Responses to Drug Therapy in Ulcerative Colitis. Digest Dis Sci. 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>
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