Pyleflebitis met ongebruikelijke etiologie

Background

Pylephlebitis is a septic thrombophlebitis of the portal vein due to an intra-abdominal infection in the drainage area of this vein.

Case description

We describe the case of a 77-year-old woman who presented at the emergency department with fever, cold chills and a two-month history of right upper quadrant abdominal pain. She was diagnosed with pylephlebitis without a clear infection site. Treatment consisted of antibiotics and anticoagulation. Two months after discharge she was again referred to the emergency department, this time with rectal blood loss. On endoscopy a cocktail stick was seen to be stuck in a diverticulum, 14 cm from the anus. The cocktail stick was endoscopically removed. In hindsight, the cocktail stick had been visible in the proximal colon on a previous abdominal CT scan. The pylephlebitis was probably due to a covered perforation of the caecum caused by the ingested cocktail stick which had then migrated to the distal colon.

Conclusion

This case illustrates the importance of discovering the aetiology of pylephlebitis to avoid possible complications.

Conflict of interest and financial support: none declared.