Pylephlebitis, an infective suppurative portal vein thrombosis, is a rare but devastating complication of untreated appendicitis or other intraabdominal or pelvic infections (eg, diverticulitis). The portal venous system drains the majority of the gastrointestinal tract; infections associated with this system lead to localized thrombophlebitis that can extend to the portal vein.
Clinical features of pylephlebitis include an acute or chronic onset of fever, right upper quadrant pain, jaundice, and hepatomegaly. Laboratory evaluation typically shows elevations in alkaline phosphatase and gamma-glutamyl transferase, and imaging (eg, CT scan, ultrasound) reveals the thrombus. Polymicrobial bacteremia is common. Treatment of pylephlebitis includes prolonged broad-spectrum antibiotic therapy to prevent complications, including bowel ischemia, portal hypertension, and hepatic abscess.