Portal pyaemia and portal vein gas - an unusual case of perforated diverticulitis

Jessica E. Hanna; Gavin J. Carmichael; Daniel Willis; Daniel N. Y. Kin; Mathew O. Jacob

doi:10.18203/2349-2902.isj20254093

Authors

Jessica E. Hanna 1Grampians Health, Ballarat, Victoria, Australia; Deakin University, Ballarat, Victoria, Australia; Grampians Research Initiative (GRIT), Ballarat, Victoria, Australia https://orcid.org/0009-0008-3977-0359
Gavin J. Carmichael Grampians Health, Ballarat, Victoria, Australia; 3Grampians Research Initiative (GRIT), Ballarat, Victoria, Australia; The University of Adelaide, Adelaide, South Australia, Australia
Daniel Willis Grampians Health, Ballarat, Victoria, Australia; Grampians Research Initiative (GRIT), Ballarat, Victoria, Australia
Daniel N. Y. Kin 1Grampians Health, Ballarat, Victoria, Australia; Deakin University, Ballarat, Victoria, Australia; Grampians Research Initiative (GRIT), Ballarat, Victoria, Australia
Mathew O. Jacob 1Grampians Health, Ballarat, Victoria, Australia; Deakin University, Ballarat, Victoria, Australia; Grampians Research Initiative (GRIT), Ballarat, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20254093

Keywords:

Portal pyaemia, Pylephlebitis, Diverticulitis, Proctosigmoidectomy

Abstract

Complicated diverticulitis is classified as having complications such as phlegmon, abscess, fistula or obstruction. A rare but life-threatening complication of diverticulitis is pylephlebitis or portal pyaemia, defined as septic thrombosis of the portal vein secondary to intra-abdominal infection. The diagnosis is often delayed due to its nonspecific clinical presentation. The study was reported the case of a 57-year old male patient who presented with abdominal pain, and initial radiological evaluation suggestive of acute uncomplicated sigmoid diverticulitis. Despite appropriate antimicrobial therapy, the patient developed persistent bacteraemia, worsening abdominal symptoms, and features of cholestasis. Contrast-enhanced computed tomography (CT) demonstrated septic thrombophlebitis originating from a branch of the inferior mesenteric vein thought to have originated from perforated sigmoid diverticulum. Broad-spectrum intravenous antibiotics were escalated; the patient underwent a minimally invasive proctosigmoidectomy and made a good recovery. This case highlights the importance of maintaining a high index of suspicion for portal pyaemia in patients with diverticulitis who fail to improve with standard therapy. Timely diagnosis and aggressive management are critical to reducing morbidity and mortality.

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