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CASE REPORT
Pylephlebitis as a postoperative complication of acute
appendicitis
Agustín A. Alesandrini1, Salvador Aguel Sabato2, Juan A. Perriello1, Isidro Moggiano2
1 Colorectal Surgeon
2 General Surgery Resident
Hospital Privado de la Comunidad, Mar del Plata, Argentina
ABSTRACT
To cite:
Alesandrini AA, Sabato SA , Perriello JA,
Moggiano I. Large Diffuse Cutaneous
Pylephlebitis is a septic thrombosis of the portal venous system secondary to intra-abdominal infections and represents a rare but
potentially severe complication of acute appendicitis. We present a case of a 52-year-old male patient diagnosed with gangrenous
appendicitis who underwent laparoscopic appendectomy. After an initially favorable postoperative course and discharge on
postoperative day 3, the patient was readmitted 72 hours later with fever and clinical deterioration. Contrast-enhanced abdominal
computed tomography revealed thrombosis of the right portal vein branch. This finding was subsequently confirmed by Doppler
ultrasonography. The patient was treated with broad-spectrum antibiotic therapy and therapeutic anticoagulation, resulting in
favorable clinical evolution and partial portal vein reperfusion during follow-up. Pylephlebitis is a condition that, if diagnosed late,
can lead to significant morbidity and mortality. It should be considered in patients who have persistent infectious symptoms
following abdominal surgery. Early recognition and prompt treatment are essential to improve outcomes and prevent severe
complications.
Metastases Secondary to Rectal Mucinous
Adenocarcinoma. Rev Argent Coloproctol.
2026; 37(2):21-24. doi:10.46768/tdkvm766
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Received: December 18, 2025
Accepted: April 20, 2026
Keywords: pylephlebitis; portal vein thrombosis; acute appendicitis; appendectomy; postoperative complications
of acute appendicitis. Laparoscopic appendectomy
was performed, and intraoperative findings were
consistent with gangrenous appendicitis. During the
procedure, the patient developed hemodynamic
instability requiring postoperative admission to the
intensive care unit (ICU).
Given his favorable postoperative course, he was
transferred to the general ward on postoperative day
2 and discharged home on postoperative day 3.
Seventy-two hours after discharge, he returned with
fever, chills, and generalized malaise. On admission,
his temperature was 38°C, white blood cell count
was 12,580/mm³, and C-reactive protein level was
11 mg/dL. Contrast-enhanced abdominal computed
INTRODUCTION
Pylephlebitis is defined as septic thrombophlebitis
of the portal vein or its tributaries secondary to an
intra-abdominal infectious process arising within
the portal venous drainage territory. Spread of
infection through the mesenteric venous system
promotes the formation of infected thrombi and
septic embolization to the liver, particularly the right
hepatic lobe, because of the physiologic pattern of
portal venous flow.1–3
This condition is an uncommon complication,
reported in fewer than 0.2% of patients with intra-
abdominal infections, although its true incidence
remains uncertain.1,2 It predominantly affects men
tomography (CT) demonstrated
a
tubular
hyperdense filling defect within the anterior right
portal vein branch consistent with portal vein
thrombosis, without evidence of intra-abdominal
collections, hepatic abscesses, or extension into the
porto-mesenteric venous system (Fig. 1). Hepatic
Doppler ultrasonography confirmed thrombosis
with absence of flow in the right portal vein branch
(Fig. 2).
A diagnosis of pylephlebitis was established, and
intravenous piperacillin-tazobactam and therapeutic
anticoagulation with low-molecular-weight heparin
were initiated. The patient remained in the ICU
during the first 3 days of readmission. Blood
cultures remained negative. He subsequently
demonstrated favorable clinical evolution with
progressive improvement in symptoms and
inflammatory markers.
Follow-up Doppler ultrasonography demonstrated
partial reperfusion of the portal venous system;
therefore, therapy was transitioned to oral
amoxicillin-clavulanate and oral anticoagulation
with apixaban (10 mg twice daily for 7 days
followed by the standard maintenance regimen).
Anticoagulation was continued for 2 months.
At 2-month follow-up, the patient remained
asymptomatic, with no evidence of recurrent
infection or thrombotic complications.
(72%–83%), with
a
mean age at presentation
ranging from 49 to 57 years.4 In adults, the most
common underlying infections are diverticulitis and
2026 The authors. Published by Revista
Argentina de Coloproctología. This article is
distributed under the Creative Commons
Attribution–NonCommercial–NoDerivatives
4.0 International License (CC BY-NC-ND
4.0)
pancreatitis,
whereas
acute
appendicitis
predominates in children and adolescents.2,3
Clinical presentation is nonspecific and includes
persistent fever, abdominal pain, jaundice, and signs
of sepsis, frequently resulting in delayed diagnosis
and treatment and, consequently, increased
morbidity and mortality. Associated complications
include hepatic abscesses, bowel ischemia, and, in
advanced cases, septic shock.5,6
nc-nd/4.0/
Microbiology is typically polymicrobial and reflects
the intestinal flora of the underlying infectious
source. Anaerobic organisms such as Bacteroides
fragilis and aerobic Gram-negative bacilli, including
Escherichia coli and Klebsiella pneumoniae are the
pathogens most frequently isolated from blood
cultures and abscesses.2,4,7
We report a case of pylephlebitis as a postoperative
complication of acute appendicitis and highlight the
importance of early diagnosis and prompt treatment
given the substantial morbidity and mortality
associated with this condition.
Correspondence to
Agustín A. Alesandrini
CASE
A 52-year-old man with no significant past medical
history presented with a typical clinical presentation
