Pylephlebitis with Bacteremia from a Rare Bacterium: A Case Report of Septic Mesenteric-Portal Thrombophlebitis Associated with Acute Diverticulitis

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Published: Jun 29, 2024
DOI: https://doi.org/10.52600/2763-583X.bjcr.2025.5.1.bjcr5
Keywords:
Colonic Diverticulitis, Bacteremia, Thrombophlebitis, Venous Thrombosis

Main Article Content

Paula Heroso Moreira
Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)
https://orcid.org/0000-0003-4941-029X
Giovana Rezende Fernandes Costa Costa
Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)
https://orcid.org/0000-0002-8999-0308
Lucas Terasoto
Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)
https://orcid.org/0009-0009-3159-2401
Gabriel da Silva Eli
Department of Radiology – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)
https://orcid.org/0000-0003-2677-6467
Barbara Loeser Faro
Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)
https://orcid.org/0009-0008-4759-499X
Pedro Henrique Garcia Parreira
Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)
https://orcid.org/0009-0000-4234-3309
Pedro Henrique Garcia Parreira
Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)
https://orcid.org/0009-0008-9769-389X
Adonis Nasr
Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)
https://orcid.org/0000-0003-2933-1922

Abstract

Pylephlebitis, defined as septic thrombophlebitis of the portal vein, is a rare complication of intra-abdominal infections, particularly appendicitis and diverticulitis. Prompt diagnosis through laboratory tests and imaging, and the early institution of antibiotic therapy, with or without anticoagulation, considerably improve the prognosis. The authors present an atypical case of pylephlebitis associated with uncomplicated acute diverticulitis, with the isolation of a rare bacterium in peripheral blood, Sutterella wadsworthensis.

Article Details

How to Cite
Moreira, P. H., Costa, G. R. F. C., Terasoto, L., Eli, G. da S., Faro, B. L., Parreira, P. H. G., Parreira, P. H. G., & Nasr, A. (2024). Pylephlebitis with Bacteremia from a Rare Bacterium: A Case Report of Septic Mesenteric-Portal Thrombophlebitis Associated with Acute Diverticulitis. Brazilian Journal of Case Reports, 5(1), bjcr5. https://doi.org/10.52600/2763-583X.bjcr.2025.5.1.bjcr5
Issue
Vol. 5 No. 1 (2025): January/December - 2025 (In progress)
Section
Clinical Case Reports
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Author Biographies

Paula Heroso Moreira, Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)

Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil

Giovana Rezende Fernandes Costa Costa, Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)

Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil

Lucas Terasoto, Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)

Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.

Gabriel da Silva Eli, Department of Radiology – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)

Department of Radiology – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.

Barbara Loeser Faro, Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)

Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.

Pedro Henrique Garcia Parreira, Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)

Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.

Pedro Henrique Garcia Parreira, Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)

Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.

Adonis Nasr, Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR)

Department of General and Gastrointestinal Surgery – Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.

References

Hartpence J, Woolf A. Pylephlebitis. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Pub-lishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563246/

Fusaro L, Di Bella S, Martingano P, Crocè LS, Giuffrè M. Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis. Diagnostics (Basel). 2023 Jan 25;13(3):429. doi: 10.3390/diagnostics13030429. PMID: 36766534; PMCID: PMC9914785.

Tang R, Tian X, Xie X, Yang Y. Intestinal Infarction Caused by Thrombophlebitis of the Portomesenteric Veins as a Com-plication of Acute Gangrenous Appendicitis After Appendectomy: A Case Report. Medicine (Baltimore). 2015 Jun;94(24). doi: 10.1097/MD.0000000000001033. PMID: 26091450; PMCID: PMC4616561.

Belhassen-García M, Gomez-Munuera M, Pardo-Lledias J, Velasco-Tirado V, Perez-Persona E, Galindo-Perez I, et al. Pylephlebitis: incidence and prognosis in a tertiary hospital. Enferm Infecc Microbiol Clin. 2014 Jun-Jul;32(6):350-4. doi: 10.1016/j.eimc.2013.09.002. Epub 2014 May 17. PMID: 24844192.

Choudhry AJ, Baghdadi YM, Amr MA, Alzghari MJ, Jenkins DH, Zielinski MD. Pylephlebitis: a Review of 95 Cases. J Gas-trointest Surg. 2016 Mar;20(3):656-61. doi: 10.1007/s11605-015-2875-3. Epub 2015 Jul 10. PMID: 26160320; PMCID: PMC4882085.

Plemmons RM, Doley DP, Longfield RN. Septic Thrombophlebitis of the Portal Vein (Pylephlebitis): Diagnosis and Man-agement in the Modern Era. Clin Infect Dis. 1995 Nov;21(5):1114-20. doi: 10.1093/clinids/21.5.1114.

Oliveira A, Lisa F, Carvalho L, Gamito M, Garcia D, Ilias E. Pileflebite: Uma Revisão Sistemática. Global J Med Res. 2022;22(3):21-26. doi: 10.34257/GJMRFVOL22IS3PG21.

Osler W. Case of Obliteration of the Portal Vein (Pylephlebitis Adhesiva). J Anat Physiol. 1882 Jan;16(Pt 2):208-16. PMID: 17231426; PMCID: PMC1310058.

Naymagon L, Tremblay D, Schiano T, Mascarenhas J. The role of anticoagulation in pylephlebitis: a retrospective examination of characteristics and outcomes. J Thromb Thrombolysis. 2020 Feb;49(2):325-31. doi: 10.1007/s11239-019-01949-z. PMID: 31493290.

Kanellopoulou T, Alexopoulou A, Theodossiades G, Koskinas J, Archimandritis AJ. Pylephlebitis: an overview of non-cirrhotic cases and factors related to outcome. Scand J Infect Dis. 2010 Dec;42(11-12):804-11. doi: 10.3109/00365548.2010.508464. Epub 2010 Aug 25. PMID: 20735334.

Nasir SA, Chambers E, Wojkiewicz S. Pylephlebitis With Splenic and Mesenteric Vein Thrombosis in a Patient With Diver-ticulitis. Cureus. 2022 Aug 29;14(8). doi: 10.7759/cureus.28524. PMID: 36185925; PMCID: PMC9516873.

Gajendran M, Muniraj T, Yassin M. Diverticulitis complicated by pylephlebitis: a case report. J Med Case Rep. 2011 Oct 10;5:514. doi: 10.1186/1752-1947-5-514. PMID: 21985694; PMCID: PMC3213015.

Lim HE, Cheong HJ, Woo HJ, Kim WJ, Kim MJ, Lee CH, et al. Pylephlebitis associated with appendicitis. Korean J Intern Med. 1999 Jan;14(1):73-6. doi: 10.3904/kjim.1999.14.1.73. PMID: 10063317; PMCID: PMC4531908.

Queiroz RM, Sampaio FDC, Marques PE, Ferez MA, Febronio EM. Pileflebite e trombose séptica da veia mesentérica inferior secundárias a diverticulite. Radiol Bras. 2018;51(5):336-7.

Balthazar EJ, Gollapudi P. Septic thrombophlebitis of the mesenteric and portal veins: CT imaging. J Comput Assist Tomogr. 2000 Sep-Oct;24(5):755-60. doi: 10.1097/00004728-200009000-00017. PMID: 11045699.

Baril N, Wren S, Radin R, Ralls P, Stain S. The role of anticoagulation in pylephlebitis. Am J Surg. 1996 Nov;172(5):449-52; discussion 452-3. doi: 10.1016/S0002-9610(96)00220-6. PMID: 8942542.

Farin P, Paajanen H, Miettinen P. Intraoperative US diagnosis of pylephlebitis (portal vein thrombosis) as a complication of appendicitis: a case report. Abdom Imaging. 1997 Jul-Aug;22(4):401-3. doi: 10.1007/s002619900220. PMID: 9157860.

Tung JY, Johnson JL, Liacouras CA. Portal-mesenteric pylephlebitis with hepatic abscesses in a patient with Crohn's disease treated successfully with anticoagulation and antibiotics. J Pediatr Gastroenterol Nutr. 1996 Nov;23(4):474-8. doi: 10.1097/00005176-199611000-00022. PMID: 8956191.

Joly V, Belmatoug N, Sibert A, Carbon C, Yeni P. Septic thrombophlebitis of the portal vein. Clin Infect Dis. 1996 Aug;23(2):417-8. doi: 10.1093/clinids/23.2.417-a. PMID: 8842302.

Dean JW, Trerotola SO, Harris VJ, Snidow JJ, Hawes D. Percutaneous management of suppurative pylephlebitis. J Vasc Interv Radiol. 1995 Jul-Aug;6(4):585-8. doi: 10.1016/s1051-0443(95)71141-1. PMID: 7579869.

Sakamoto H, Suga M, Ozeki I, Kobayashi T, Sugaya T, Sasaki Y, et al. Subcapsular hematoma of the liver and pylethrombosis in the setting of cholestatic liver injury. J Gastroenterol. 1996 Dec;31(6):880-4. doi: 10.1007/BF02358619. PMID: 9027656.

Hale GR, Sakkal LA, Galanis T. Pylephlebitis treated with apixaban. Hosp Pract (1995). 2019 Oct;47(4):192-5. doi: 10.1080/21548331.2019.1670476. Epub 2019 Sep 28. PMID: 31545676.

Plemmons RM, Dooley DP, Longfield RN. Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and man-agement in the modern era. Clin Infect Dis. 1995;21:1114.

Mellor TE, Mitchell N, Logan J. Lemierre's syndrome variant of the gut. BMJ Case Rep. 2017;2017

. doi: 10.1136/bcr-2017-222178.

Hale GR, Sakkal LA, Galanis T. Pylephlebitis treated with apixaban. Hosp Pract (1995). 2019;47:192-5. doi: 10.1080/21548331.2019.1670476.

Abughanimeh O, Tahboub M, Zafar Y, Abu Ghanimeh M. Pylephlebitis Caused by Actinomyces Bacteremia. Cureus. 2018;10

. doi: 10.7759/cureus.2887.

Kirk KF, Andersen KL, Tarpgaard IH, Nielsen HL. Three cases of Sutterella wadsworthensis bacteremia secondary to ab-dominal infections. Anaerobe. 2021;72:102460. doi: 10.1016/j.anaerobe.2021.102460.

Zhang F, Hang X, Fan X, Li G, Yang H. Selection and optimization procedure of synbiotic for cholesterol removal. Anaerobe. 2007 Oct;13(5-6):185-92. doi: 10.1016/j.anaerobe.2007.07.001.

Alberts R, de Vries EM, Goode EC, Jiang X, Sampaziotis F, Rombouts K, et al. Genetic association analysis identifies variants associated with disease progression in primary sclerosing cholangitis. Gut. 2017 Aug;67(8):1517-24. doi: 10.1136/gutjnl-2016-313539.

Kaakoush NO. Sutterella species, IgA-degrading bacteria in ulcerative colitis. Trends Microbiol. 2020 Jul;28(7):519-22. doi: 10.1016/j.tim.2020.02.018.

Mukhopadhya I, Hansen R, Nicholl CE, Alhaidan YA, Thomson JM, Berry SH, et al. A comprehensive evaluation of colonic mucosal isolates of Sutterella wadsworthensis from inflammatory bowel disease. PLoS One. 2011 Oct 31;6(10)

. doi: 10.1371/journal.pone.0027076. PMID: 22073125; PMCID: PMC3205041.

Brunaud L, Antunes L, Collinet-Adler S, et al. Acute mesenteric venous thrombosis: Case for nonoperative management. J Vasc Surg. 2001;34(4):673-9. doi: 10.1067/mva.2001.117422.

Morasch MD, Ebaugh JL, Chiou AC, et al. Mesenteric venous thrombosis: A changing clinical entity. J Vasc Surg. 2001;34(4):680-4. doi: 10.1067/mva.2001.117423.

Grisham A, Lohr J, Guenther JM, et al. Deciphering mesenteric venous thrombosis: Imaging and treatment. Vasc Endovascular Surg. 2005;39(5):473-9. doi: 10.1177/153857440503900507.

Maldonado TS, Blumberg SN, Sheth SU, et al. Mesenteric vein thrombosis can be safely treated with anticoagulation but is associated with significant sequelae of portal hypertension. J Vasc Surg Venous Lymphat Disord. 2016;4(4):400-6. doi: 10.1016/j.jvsv.2016.01.004.

Hollingshead M, Burke CT, Mauro MA, et al. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol. 2005;16(5):651-61. doi: 10.1097/01.RVI.0000159558.15207.7b.

Northup PG, Garcia-Pagan JC, Garcia-Tsao G, Intagliata NM, Superina RA, Roberts LN, et al. Vascular liver disorders, portal vein thrombosis, and procedural bleeding in patients with liver disease: 2020 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73(1):366-413. doi: 10.1002/hep.31646.

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