Fatal outcome of pylephlebitis treated with transhepatic percutaneous drainage

Pylephlebitis, also called suppurative endophlebitis of the portal vein, is a rare potentially life-threatening acute abdominal complication of an intra-abdominal inflammatory process. Only early recognition substantially reduces the catastrophic mortality. As its clinical picture is fairly nonspecific, radiological findings, while not pathognomonic, are of great use in early diagnosis and management of these patients. We report a rare case of pylephlebitis with no identified intraperitoneal septic process in a 75-year-old man. Diagnosis was suspected on imaging features and confirmed with percutaneous transhepatic needle puncture. Thereafter, a drainage catheter was placed into the intrahepatic portal system. After a transient clinical improvement during the three following days, the drainage stopped and the patient developed a septic shock requiring transfer to intensive care but he died approximately 24 h later.