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Case Reports
. 2025 Jul 28;17(7):e88883.
doi: 10.7759/cureus.88883. eCollection 2025 Jul.

Acute Appendicitis Complicated by Superior Mesenteric Vein Thrombosis: A Rare Case of Pylephlebitis in a Healthy Young Male

Usamah Al-Anbagi  1 , Hatem Abdulmajeed  2 , Abdulqadir J Nashwan  3
Affiliations
Case Reports

Acute Appendicitis Complicated by Superior Mesenteric Vein Thrombosis: A Rare Case of Pylephlebitis in a Healthy Young Male

Usamah Al-Anbagi et al. Cureus. .

Abstract

Pylephlebitis is a rare but potentially life-threatening complication of various intra-abdominal infections, characterized by septic thrombophlebitis of the portal venous system. It is most commonly associated with conditions such as appendicitis, diverticulitis, cholecystitis, and other sources of abdominal sepsis. When the thrombosis extends to the superior mesenteric vein, it can result in bowel ischemia, infarction, and even death if not promptly diagnosed and treated. We present the case of a 29-year-old man with no prior comorbidities who developed acute appendicitis complicated by thrombosis of the superior mesenteric and ileocolic veins. He underwent a successful laparoscopic appendectomy and was treated with anticoagulation therapy. The patient showed steady clinical improvement and was discharged on oral anticoagulation after a 12-day hospital stay, with complete recovery observed at follow-up visits conducted one week and two weeks after discharge. This case underscores the importance of early recognition of pylephlebitis in intra-abdominal infections and demonstrates that prompt surgical and anticoagulation management can lead to favorable outcomes.

Keywords: acute appendicitis; antibiotics; anticoagulation therapy; computed tomography scan; mesenteric vein thrombosis; pylephlebitis.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. The Medical Research Center at Hamad Medical Corporation issued approval MRC-04-25-805. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Coronal CT abdomen demonstrating features of acute appendicitis
A CT scan of the abdomen in coronal view reveals inflammatory fat stranding surrounding the appendix. The black arrows indicate the appendix, with surrounding stranding consistent with acute appendicitis.
Figure 2
Figure 2. Coronal CT abdomen showing concurrent SMVT and acute appendicitis
A CT scan of the abdomen in coronal view demonstrates a filling defect in the SMV, consistent with venous thrombosis (red arrow). The appendix appears inflamed with a thickened wall, suggestive of acute appendicitis (blue arrow). SMV, superior mesenteric vein; SMVT, superior mesenteric vein thrombosis
Figure 3
Figure 3. Sagittal CT abdomen showing SMVT
A CT scan of the abdomen in sagittal view reveals a filling defect in the SMV, consistent with thrombosis. The blue arrow indicates the site of the thrombus. SMV, superior mesenteric vein; SMVT, superior mesenteric vein thrombosis
See this image and copyright information in PMC

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