An unconventional therapeutic approach for a severe case of septic pylephlebitis involving the portal system using pharmacomechanical thrombolysis and thrombectomy.

Pylephlebitis has a high risk of mortality. Even with optimal medical management, the thrombus may propagate and require intervention. We present one such case in which extension of the thrombus from the superior mesenteric vein to the intrahepatic portal veins led to a life-threatening systemic response. Current endovascular techniques tailored with targeted pharmacomechanical thrombolytic therapy were combined with an exploratory laparotomy for septic control and resulted in an accelerated recovery.