Pylephlebitis as a Complication of Diverticulitis
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A 45-year-old man presented to the emergency department with a 4-day history of fever and jaundice. Initial workup revealed leukocytosis and elevated aminotransferase levels that indicated possible cholangitis. Despite broad-spectrum antibiotic therapy, the patient did not have clinical improvement. A computed tomographic scan showed acute perforated sigmoid diverticulitis (Panels A and B, arrow) and gas in the mesentery (Panels A and B, white arrowheads). In addition, there was gas in the inferior mesenteric vein extending to the splenic vein up to the origin of the portal vein (Panel A, red arrowheads), a finding that was consistent with pylephlebitis. Fat stranding around the inferior mesenteric vein, indicating inflammation, was also noted, and there were peripheral linear collections of gas in the liver. An emergency Hartmann’s procedure was performed, and the patient received antibiotic therapy against Escherichia coli, which grew on culture, with no anticoagulation therapy...

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