Acute pylephlebitis secondary to perforated sigmoid diverticulitis: A case report

Pylephlebitis is defined as the development of portal venous thrombosis secondary to intra–abdominal infection or inflammation. We present the case of a 69-year-old male with pylephlebitis who attended the Emergency Department with nonspecific abdominal pain, rigors and deranged liver function tests. After an initial negative ultrasound study, computed tomography (CT) scanning demonstrated perforated diverticulitis with an associated thrombus within the portal venous system. Prompt imaging coupled with a high index of clinical suspicion helps in identifying this condition early, significantly reducing morbidity and mortality rates. This case emphasizes the importance of careful evaluation of the portal venous system in cases of intra–abdominal sepsis to exclude this rare, and sometimes fatal, condition.