A Case Of Pylephlebitis Without An Obvious Source Following Gastric Cancer Resection

Background: Pylephlebitis, an extremely rare but fatal condition, is defined as septic thrombophlebitis of the portal vein. It is usually associated with intra-abdominal infection, and its clinical features are non-specific. We describe a case of pylephlebitis following gastric cancer resection while no primary intra-abdominal abscess was noted. Methods: A 69-year-old man with gastric cancer was admitted for surgery and the procedure was uneventful. On postoperative day (POD) 10, he suddenly developed a fever and presented with abdominal distention without any other complaint. Enhanced CT scanning revealed a thrombus in the left branch of the portal vein, but no intra-abdominal abscess was noted. On the 3rd day after diagnosis of pylephlebitis his conditions progressively deteriorated leading to septic shock and disturbance of consciousness. Antibiotics, anticoagulation therapy, and continuous renal replacement therapy were performed and his condition dramatically improved. Results: The patient was successfully treated and a follow-up CT scan showed complete resolution of the portal vein thrombus. Conclusion: It is important to highlight the possibility of pylephlebitis in patients with unknown sepsis, even if obvious abdominal symptoms or signs are not identified.