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Case Reports
. 2018 Nov 4:2018:3931674.
doi: 10.1155/2018/3931674. eCollection 2018.

A Rare Case of Pylephlebitis as a Complication of Cholecystocolonic Fistula

Kouki Imaoka  1   2 , Saburo Fukuda  1 , Hirofumi Tazawa  3 , Sotaro Fukuhara  1 , Yuzo Hirata  1 , Seiji Fujisaki  1 , Mamoru Takahashi  1 , Hideto Sakimoto  1   4
Affiliations
Case Reports

A Rare Case of Pylephlebitis as a Complication of Cholecystocolonic Fistula

Kouki Imaoka et al. Case Rep Surg. .

Abstract

Pylephlebitis is defined as a septic thrombophlebitis of the portal vein and its tributaries that is associated with multiple suppurative abdominal infections. We report a case of pylephlebitis associated with a cholecystocolonic fistula (CCF). A 41-year-old man presented with upper abdominal pain and anorexia for 1 month. Abdominal contrast-enhanced computed tomography (CT) revealed thrombosis in the left and anterior branch of the portal vein and thickening of the walls of the portal vein and periside portals. The gallbladder was collapsed and pneumobilia was seen in the biliary tract. Blood culture was positive for Streptococcus anginosus. A diagnosis of thrombophlebitis of the portal vein associated with CCF was made, and the patient was immediately managed with an intravenous broad-spectrum antibiotic and anticoagulation. After the portal vein thrombosis (PVT) propagation and inflammation had subsided, cholecystectomy and partial resection of the transverse colon were performed. Pylephlebitis is rare but is a life-threatening complication of intra-abdominal infection. A high index of suspicion is required, and a CT scan should be performed immediately for an early diagnosis and appropriate treatment.

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Figures

Figure 1
Figure 1
Enhanced computed tomography (CT) showed massive portal vein thrombosis (black arrows). Only the portal branch of segment 6 is patent (white arrow). The gallbladder was collapsed and pneumobilia was seen in the biliary tract (asterisk) (a, b).
Figure 2
Figure 2
Doppler ultrasonography (US) showed a dilated duct-like structure without any flow in the umbilical portion of the liver (a). Blood flow was detected only in the portal branch of segment 6 (b).
Figure 3
Figure 3
Magnetic resonance imaging (MRI) showed a fistula between the gallbladder and the colon (white arrow). A gallstone in the gallbladder was seen (yellow arrow), but no other gallstone was seen in the common bile duct by cholangiopancreatography (MRCP).
Figure 4
Figure 4
Intraoperative picture indicates that the transverse colon is tightly adherent to the fundus of the gallbladder (white arrow).
See this image and copyright information in PMC

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