Treatment with antibiotics alone for perforated diverticulitis complicated by pylephlebitis and mesenteric venous thrombosis

Pylephlebitis is defined as septic thrombophlebitis of the portal vein and its branches. Although rare, portal mesenteric venous thrombosis and pylephlebitis can remain as potentially life-threatening sequelae of ruptured diverticulitis. Treatment recommendations from recent reports have included urgent exploratory laparotomy, prolonged intravenous antibiotic therapy, and anticoagulation for up to a year. In this paper, we describe a 67-year-old male who had fever, right upper abdominal pain and low back pain associated with shortness of breath and tea color urine at the time of admission. Laboratory test showed leukocytosis and jaundice. Computed tomography revealed perforated diverticulitis with pericolic abscess. Mesenteric venous thrombosis and pylephlebitis were present. Broad-spectrum intravenous antibiotics were administered promptly as the sole form of treatment for two weeks, after which time the patient was discharged without evidence of adverse sequelae. Follow-up computed tomography three months later revealed total resolution of pericolic abscess and regressive portal venous thrombosis. Our report emphasizes that for patients with pylephlebitis and intra-abdominal infections, prompt administration of antibiotics alone is an acceptable alternative to surgery and prolonged anticoagulation therapy.