Pylephlebitis: A Rare but Redoubtable Complication of Intra-Abdominal Infections—A Series of 15 Cases

Pylephlebitis is the suppurative thrombosis of the portal vein system. Mainly reported as a severe complication of diverticulitis or appendicitis, it is an uncommon intra-abdominal infection: approximately 200 cases have been reported in the English literature, mostly from surgical wards. Our study aims to assess the role of an infectious disease setting in managing pylephlebitis. We reviewed medical records from 2001 to 2024 at a tertiary infectious diseases hospital and identified 15 cases. The median age was 58 years [IQR = 28], with a male-to-female ratio of 4:1. Along with portal vein thrombosis (PVT), liver abscess(es) was/were the main radiological finding (<i>n</i> = 12), representing 80% of cases. The liver abscesses appear as secondary events in the case of pylephlebitis. In seven of 15 cases, we found the primary event associated with pylephlebitis. Blood cultures were positive in eight cases, with Gram-negative aerobic bacteria being commonly isolated (<i>n</i> = 5), followed by anaerobes (<i>n</i> = 3); in half of the cases, more than one pathogen was involved. All patients received broad-spectrum antibiotics containing beta-lactams, including eight who received carbapenems. Anticoagulation therapy was used in 14 cases. Two deaths were recorded, and four patients required surgical intervention, highlighting the importance of prompt diagnosis and swift antibiotic and anticoagulant treatment.