Splenoportal pylephlebitis: When the gut and the veins conspire
DOI:
https://doi.org/10.59093/27112330.147Keywords:
pylephlebitis, splenoportal thrombosis, bacteremia, sepsis, anticoagulation agents.Abstract
Pylephlebitis, also known as infectious thrombosis of the portal venous system, is a serious complication of intra-abdominal infections, with a low incidence, but a high mortality rate. We report the case of a 75-year-old man with a history of high blood pressure and colon cancer in remission, who consulted for diarrhea, fever, abdominal pain, and coluria. In paraclinical studies, thrombocytopenia and elevated nitrogen levels were found. Abdominal tomography revealed portal and splenic vein thrombosis, gas at the splenomesenteric confluence, and rectosigmoid thickening, with no signs of portal hypertension. During hospitalization, bacteremia due to Bacteroides fragilis and extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli was documented, confirming the diagnosis of septic splenoportal thrombophlebitis. The patient was treated with meropenem for six weeks and anticoagulation for three months, with favorable clinical evolution. This case highlights the importance of considering pylephlebitis in patients with abdominal infections and systemic signs and illustrates the need for a timely and multidisciplinary diagnostic and therapeutic approach.
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