Gajendran et al. Journal of Medical Case Reports 2011, 5:514 http://www.jmedicalcasereports.com/content/5/1/514 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Diverticulitis complicated by pylephlebitis: a case report Mahesh Gajendran1*, Thiruvengadam Muniraj2 and Mohamed Yassin2 Abstract Introduction: Pylephlebitis is defined as septic thrombophlebitis of the portal venous system, usually secondary to infection or inflammation in the abdomen. In the current report, we present a case of pylephlebitis that complicated the course of a very common pathology, diverticulitis. Case presentation: A 62-year-old Caucasian woman with a history of sigmoid diverticulitis presented to our facility with a three-week history of abdominal pain, fevers, chills, loss of appetite and fatigue. Her laboratory test results showed leukocytosis and elevated alkaline phosphatase. A computed tomography scan revealed portal vein thrombosis and a sigmoid diverticulitis with an abscess. Our patient was given pipercillin-tozabactam followed by sigmoid colectomy and loop transverse colostomy. A peritoneal fluid sample culture grew Escherichia coli. Our patient had an uneventful post-operative course and the leukocytosis resolved in the next four days. She improved clinically and was discharged home on ertapenem and enoxaparin. A follow-up computed tomography scan two weeks later showed a new pelvic abscess that was drained by a pigtail catheter but there was no change in the portal venous thrombus. A repeat computed tomography scan one month later revealed resolution of the pelvic abscess but persistence of portal vein thrombus, for which enoxaparin was continued. Conclusions: This is a classic case of pylephlebitis that demonstrates the importance of recognizing that the portal vein thrombus is infected and treating the condition appropriately. Introduction Pylephlebitis is defined as septic thrombophlebitis of the portal venous system, usually secondary to infection or inflammation in the abdomen. The common causes include diverticulitis, appendicitis or cholangitis [1]. Pylephlebitis has to be differentiated from the bland portal vein thrombus. Bland portal vein thrombosis is more common than pylephlebitis and the management is different. Here, we present a case of pylephlebitis that complicated the course of a very common pathology, diverticulitis. Case presentation A 62-year-old Caucasian woman with a history of sig- moid diverticulitis (seven months prior to admission) was admitted for three weeks of sharp intermittent left lower quadrant abdominal pain, low-grade fever, chills, loss of * Correspondence: gajendranm@upmc.edu 1University of Pittsburgh Medical Centre, Department of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA Full list of author information is available at the end of the article appetite and fatigue. She denied diarrhea, bloody stools, nausea, or vomiting. The only abnormal finding on physi- cal examination was tenderness in the left lower quad- rant. Her initial laboratory test results showed a white cell count of 17,700 cells/mm3, hemoglobin 13.7 gm/dL and elevated alkaline phosphatase two times the normal level. A computed tomography (CT) scan of the abdo- men revealed portal vein thrombosis, low attenuation liver lesions (Figures 1, 2, 3) and extensive sigmoid diver- ticulitis with a 4 × 1.8 cm abscess. This was a new throm- bus compared to a previous CT scan, performed two months previously. The color doppler confirmed the pre- sence of portal vein thrombus (Figure 4). An MRI scan of the abdomen did not reveal any additional information. Our patient was given pipercillin-tozabactam followed by exploratory laparotomy, sigmoid colectomy and loop transverse colostomy. An intra-operative ultrasonography of the liver was suggestive of early liver abscesses, but we were not able to aspirate. A peritoneal fluid sample cul- ture grew Escherichia coli. Our patient had an uneventful post-operative course and her leukocytosis resolved in © 2011 Gajendran et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.