Maejima Takuya, Hashimoto Etaro, Hirose Kazuhito, Miyazaki Kenji, Suzuki Masatsune, Maeno Tetsuhiro
Department of General Medicine, Kasama City Hospital, Kasama, JPN.
Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba / University of Tsukuba Hospital, Tsukuba, JPN.
Cureus. 2024 Nov 9;16(11):e73358. doi: 10.7759/cureus.73358. eCollection 2024 Nov.
Pylephlebitis is a rare infection, characterized by non-specific symptoms such as abdominal pain, that often leads to delayed diagnosis, yet it is a severe infection with a high mortality rate. Imaging studies are essential for diagnosis, and contrast-enhanced abdominal CT and abdominal ultrasound are commonly performed. A 51-year-old male was admitted to the hospital with fever and shock. Blood tests revealed liver and kidney dysfunction. Contrast-enhanced computed tomography (CT) is the best modality to demonstrate the portal vein abnormalities and diverticulitis. But plain abdominal CT was performed due to renal impairment, revealing findings suggestive of small bowel diverticulitis and paralytic ileus. Septic shock, presumably caused by bacterial translocation secondary to paralytic ileus, was diagnosed, and meropenem was initiated. Subsequent abdominal ultrasound revealed thrombosis in the portal vein and an abscess in the region suspected of being affected by small bowel diverticulitis. Based on these findings, it was concluded that the patient developed pylephlebitis, septic shock, and paralytic ileus as a result of small bowel diverticulitis and the associated abscess formation. Oral amoxicillin/clavulanate was continued until the abscess resolved. Pylephlebitis often progresses to septic shock, as seen in the present case. In severe cases of intra-abdominal infections, such as diverticulitis, it is necessary to consider the possibility of pylephlebitis and actively perform imaging studies to confirm the diagnosis. Additionally, in cases where contrast-enhanced CT cannot be performed, abdominal ultrasound is useful for diagnosis.
门静脉炎是一种罕见的感染性疾病，其特征为腹痛等非特异性症状，常导致诊断延迟，然而它是一种严重感染，死亡率很高。影像学检查对诊断至关重要，通常会进行腹部增强CT和腹部超声检查。一名51岁男性因发热和休克入院。血液检查显示肝肾功能不全。腹部增强计算机断层扫描（CT）是显示门静脉异常和憩室炎的最佳检查方式。但由于肾功能损害，进行了普通腹部CT检查，结果提示小肠憩室炎和麻痹性肠梗阻。诊断为可能由麻痹性肠梗阻继发细菌移位引起的感染性休克，并开始使用美罗培南治疗。随后的腹部超声检查显示门静脉血栓形成以及疑似受小肠憩室炎影响区域有脓肿。基于这些发现，得出结论：患者因小肠憩室炎及相关脓肿形成而发展为门静脉炎、感染性休克和麻痹性肠梗阻。持续口服阿莫西林/克拉维酸直至脓肿消退。如本病例所示，门静脉炎常进展为感染性休克。在严重的腹腔内感染病例中，如憩室炎，有必要考虑门静脉炎的可能性并积极进行影像学检查以确诊。此外，在无法进行腹部增强CT检查的情况下，腹部超声对诊断很有用。
