Vaskuler Nedenli Karın Ağrıları (3): Portal Ven Trombozu ve Pileflebitis
Özet
Portal ven trombozu (PVT) ve spesifik bir alt tipi olan pileflebit (septik portal ven trombozu), gastrointestinal sistemin venöz drenajını etkileyen ve acil servis pratiğinde yüksek morbidite ve mortalite potansiyeli taşıyan vasküler acillerdir. PVT, azalan portal venöz akım, endotel hasarı ve hiperkoagülabilite zemininde gelişirken; pileflebit genellikle divertikülit veya apandisit gibi intraabdominal süpüratif enfeksiyonların nadir fakat katastrofik bir komplikasyonu olarak ortaya çıkar. Hastalarda klinik prezentasyon çoğunlukla nonspesifik karın ağrısı, inatçı ateş ve sistemik inflamatuar yanıt sendromu bulgularından oluştuğu için tanı sıklıkla gecikebilmekte ve intestinal iskemi gibi ölümcül sonuçlara yol açabilmektedir. Kontrastlı batın bilgisayarlı tomografisi, her iki tablonun kesin tanısında, anatomik trombus yaygınlığının belirlenmesinde ve altta yatan enfektif odakların gösterilmesinde altın standart görüntüleme yöntemidir. Acil servis yönetiminde majör kanama kontrendikasyonu bulunmayan tüm hastalarda, trombus progresyonunu durdurmak ve damar rekanalizasyonunu sağlamak amacıyla erken antikoagülan tedavi (düşük molekül ağırlıklı heparin veya direkt oral antikoagülanlar) başlanması kritik öneme sahiptir. Karar sürecinde siroz varlığı mutlaka dışlanmalı ve portal hipertansiyona sekonder varis kanaması riski göz önünde bulundurulmalıdır. Pileflebit olgularında tablo agresif bir sepsis odağı olarak kabul edilmeli; antikoagülasyona ek olarak hızla kan kültürleri alınmalı, anaerobları da kapsayan ampirik geniş spektrumlu intravenöz antibiyoterapiye başlanmalı ve primer enfeksiyon odağının cerrahi veya perkütan drenajı sağlanmalıdır. Bu derleme, PVT ve pileflebitin epidemiyolojisi, patofizyolojisi, klinik bulguları ve multidisipliner tedavi algoritmalarını güncel literatür ile acil tıp pratiği için özetlemeyi amaçlamaktadır.
Portal vein thrombosis (PVT) and its specific subtype, pylephlebitis (septic portal vein thrombosis), are high-mortality vascular emergencies affecting the venous drainage of the gastrointestinal tract that require early recognition in emergency department practice. While PVT develops in the setting of decreased portal venous flow, endothelial damage, and hypercoagulability, pylephlebitis typically occurs as a rare but catastrophic complication of intra-abdominal suppurative infections such as diverticulitis or appendicitis. Since the clinical presentation predominantly consists of nonspecific abdominal pain, refractory fever, and systemic inflammatory response syndrome, diagnosis is frequently delayed, potentially leading to fatal consequences like intestinal ischemia. Contrast-enhanced abdominal computed tomography is the gold standard imaging modality for the definitive diagnosis of both conditions, determination of anatomical thrombus extension, and identification of underlying infective foci. In emergency management, the early initiation of anticoagulant therapy (low-molecular-weight heparin or direct oral anticoagulants) is crucial to arrest thrombus progression and achieve vessel recanalization in all patients without major bleeding contraindications. During the decision-making process, the presence of cirrhosis must be excluded, and the risk of variceal bleeding secondary to portal hypertension should be considered. In cases of pylephlebitis, the clinical picture must be managed as an aggressive sepsis focus; in addition to anticoagulation, blood cultures should be drawn rapidly, empirical broad-spectrum intravenous antibiotic therapy covering anaerobes must be initiated, and surgical or percutaneous drainage of the primary infection source should be ensured. This review aims to summarize the epidemiology, pathophysiology, clinical manifestations, and multidisciplinary treatment algorithms of PVT and pylephlebitis for emergency medicine practice in light of current literature.
Referanslar
Rühl H, Reda S. Management of Splanchnic Venous Thrombosis: An Update. Hamostaseologie. 2026 Feb;46(01):071–7. doi:10.1055/a-2749-6835
Pan J, Wang L, Gao F, An Y, Yin Y, Guo X, et al. Epidemiology of portal vein thrombosis in liver cirrhosis: A systematic review and meta-analysis. Eur J Intern Med. 2022 Oct;104:21–32. doi:10.1016/j.ejim.2022.05.032 PubMed PMID: 35688747.
Nery F, Chevret S, Condat B, de Raucourt E, Boudaoud L, Rautou PE, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study. Hepatology. 2015 Feb;61(2):660–7. doi:10.1002/hep.27546 PubMed PMID: 25284616.
Fusaro L, Di Bella S, Martingano P, Crocè LS, Giuffrè M. Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis. Diagnostics (Basel). 2023 Jan 25;13(3):429. doi:10.3390/diagnostics13030429 PubMed PMID: 36766534; PubMed Central PMCID: PMC9914785.
Choudhry AJ, Baghdadi YMK, Amr MA, Alzghari MJ, Jenkins DH, Zielinski MD. Pylephlebitis: a Review of 95 Cases. J Gastrointest Surg. 2016 Mar;20(3):656–61. doi:10.1007/s11605-015-2875-3 PubMed PMID: 26160320; PubMed Central PMCID: PMC4882085.
Naymagon L, Tremblay D, Schiano T, Mascarenhas J. The role of anticoagulation in pylephlebitis: a retrospective examination of characteristics and outcomes. J Thromb Thrombolysis. 2020 Feb;49(2):325–31. doi:10.1007/s11239-019-01949-z PubMed PMID: 31493290.
Harris M, Thachil J. Portal vein thrombosis – a primer for the general physician. Clinical Medicine. 2017 Jun;17(3):212–9. doi:10.7861/clinmedicine.17-3-212
Simonetto DA, Singal AK, Garcia-Tsao G, Caldwell SH, Ahn J, Kamath PS. ACG Clinical Guideline: Disorders of the Hepatic and Mesenteric Circulation. Am J Gastroenterol. 2020 Jan;115(1):18–40. doi:10.14309/ajg.0000000000000486
Elkrief L, Hernandez-Gea V, Senzolo M, Albillos A, Baiges A, Berzigotti A, et al. Portal vein thrombosis: diagnosis, management, and endpoints for future clinical studies. The Lancet Gastroenterology & Hepatology. 2024 Sep;9(9):859–83. doi:10.1016/S2468-1253(24)00155-9
Davis JPE, Lim JK, Francis FF, Ahn J. AGA Clinical Practice Update on Management of Portal Vein Thrombosis in Patients With Cirrhosis: Expert Review. Gastroenterology. 2025 Feb;168(2):396-404.e1. doi:10.1053/j.gastro.2024.10.038
Francoz C, Valla D, Durand F. Portal vein thrombosis, cirrhosis, and liver transplantation. Journal of Hepatology. 2012 Jul;57(1):203–12. doi:10.1016/j.jhep.2011.12.034
Amitrano L, Anna Guardascione M, Brancaccio V, Margaglione M, Manguso F, Iannaccone L, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. Journal of Hepatology. 2004 May;40(5):736–41. doi:10.1016/j.jhep.2004.01.001
Harding DJ, Perera MTP, Chen F, Olliff S, Tripathi D. Portal vein thrombosis in cirrhosis: Controversies and latest developments. WJG. 2015 Jun 14;21(22):6769–84. doi:10.3748/wjg.v21.i22.6769
Yerdel MA, Gunson B, Mirza D, Karayalçin K, Olliff S, Buckels J, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000 May 15;69(9):1873–81. doi:10.1097/00007890-200005150-00023 PubMed PMID: 10830225.
Tripodi A, Mannucci PM. The Coagulopathy of Chronic Liver Disease. N Engl J Med. 2011 Jul 14;365(2):147–56. doi:10.1056/NEJMra1011170
Turon F, Driever EG, Baiges A, Cerda E, García-Criado Á, Gilabert R, et al. Predicting portal thrombosis in cirrhosis: A prospective study of clinical, ultrasonographic and hemostatic factors. J Hepatol. 2021 Dec;75(6):1367–76. doi:10.1016/j.jhep.2021.07.020 PubMed PMID: 34333101.
Singal AK, Kamath PS, Tefferi A. Mesenteric Venous Thrombosis. Mayo Clinic Proceedings. 2013 Mar;88(3):285–94. doi:10.1016/j.mayocp.2013.01.012
Stefano VD, Qi X, Betti S, Rossi E. Splanchnic vein thrombosis and myeloproliferative neoplasms: molecular-driven diagnosis and long-term treatment. Thromb Haemost. 2016 Mar;115(02):240–9. doi:10.1160/th15-04-0326
Greenfield G, McMullin MF. Splanchnic venous thrombosis in JAK2 V617F mutation positive myeloproliferative neoplasms – long term follow-up of a regional case series. Thrombosis J. 2018 Dec;16(1):33. doi:10.1186/s12959-018-0187-z
Northup PG, Garcia-Pagan JC, Garcia-Tsao G, Intagliata NM, Superina RA, Roberts LN, et al. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73(1):366–413. doi:10.1002/hep.31646 PubMed PMID: 33219529.
Hernández-Gea V, De Gottardi A, Leebeek FWG, Rautou PE, Salem R, Garcia-Pagan JC. Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis. Journal of Hepatology. 2019 Jul;71(1):175–99. doi:10.1016/j.jhep.2019.02.015
Turon F, Cervantes F, Colomer D, Baiges A, Hernández-Gea V, Garcia-Pagán JC. Role of calreticulin mutations in the aetiological diagnosis of splanchnic vein thrombosis. Journal of Hepatology. 2015 Jan;62(1):72–4. doi:10.1016/j.jhep.2014.08.032
Gioia S, Nardelli S, Ridola L, d’Amati G, Riggio O. Is porto sinusoidal vascular disease to be actively searched in patients with portal vein thrombosis? WJH. 2019 Aug 27;11(8):613–8. doi:10.4254/wjh.v11.i8.613
Gil-Lopez F, Rios-Olais FA, Mercado LA, Harnois DM. Portal Vein Thrombosis in Patients Without Cirrhosis: Current Practical Approaches and Treatment Strategies. Diagnostics. 2025 Mar 13;15(6):721. doi:10.3390/diagnostics15060721
Zocco MA, Di Stasio E, De Cristofaro R, Novi M, Ainora ME, Ponziani F, et al. Thrombotic risk factors in patients with liver cirrhosis: Correlation with MELD scoring system and portal vein thrombosis development. Journal of Hepatology. 2009 Oct;51(4):682–9. doi:10.1016/j.jhep.2009.03.013
Rautou PE, Moga L, Hernandez-Gea V, Ageno W, Darwish Murad S, Garcia-Pagan JC, et al. EASL Clinical Practice Guidelines on vascular diseases of the liver. Journal of Hepatology. 2026 Feb;84(2):399–456. doi:10.1016/j.jhep.2025.08.001
Yuan C, Guo K, Wang N, Wang H, Wu S, Zhu Y, et al. Successful management of acute superior mesenteric infarction caused by extensive portal-mesenteric venous thrombosis: a case report. AME Case Rep. 2026;10:20. doi:10.21037/acr-2025-249 PubMed PMID: 41676215; PubMed Central PMCID: PMC12885853.
Lee H, Han YH, Chung JW, Kim KO, Kwon KA, Kim JH. Upper gastrointestinal bleeding with duodenal varix: A case report. World J Clin Cases. 2026 Feb 6;14(4):116648. doi:10.12998/wjcc.v14.i4.116648 PubMed PMID: 41695764; PubMed Central PMCID: PMC12897486.
de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959–74. doi:10.1016/j.jhep.2021.12.022 PubMed PMID: 35120736; PubMed Central PMCID: PMC11090185.
De Gaetano AM, Lafortune M, Patriquin H, De Franco A, Aubin B, Paradis K. Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic collateral circulation detected with Doppler sonography. AJR Am J Roentgenol. 1995 Nov;165(5):1151–5. doi:10.2214/ajr.165.5.7572494 PubMed PMID: 7572494.
Chandok N, Watt KDS. Pain Management in the Cirrhotic Patient: The Clinical Challenge. Mayo Clinic Proceedings. 2010 May;85(5):451–8. doi:10.4065/mcp.2009.0534
Swetz KM, Carey EC, Rho RH, Mauck WD, Whitford KJ, Moynihan TJ, et al. Safe Use of Opioids to Manage Pain in Patients With Cirrhosis. Mayo Clinic Proceedings. 2010 Oct;85(10):959. doi:10.4065/mcp.2010.0294
Kasper DL, Sahani D, Misdraji J. Case 25-2005: A 40-Year-Old Man with Prolonged Fever and Weight Loss. Cabot RC, Harris NL, Shepard JAO, Ebeling SH, Ellender SM, Peters CC, editors. N Engl J Med. 2005 Aug 18;353(7):713–22. doi:10.1056/NEJMcpc059020
Kanellopoulou T, Alexopoulou A, Theodossiades G, Koskinas J, Archimandritis AJ. Pylephlebitis: An overview of non-cirrhotic cases and factors related to outcome. Scandinavian Journal of Infectious Diseases. 2010 Dec;42(11–12):804–11. doi:10.3109/00365548.2010.508464
Osler W. Case of Obliteration of the Portal Vein (Pylephlebitis Adhesiva). J Anat Physiol. 1882 Jan;16(Pt 2):208–16. PubMed PMID: 17231426; PubMed Central PMCID: PMC1310058.
Takahashi H, Sakata I, Adachi Y. Treatment of portal vein septic thrombosis by infusion of antibiotics and an antifungal agent into portal vein and superior mesenteric artery: a case report. Hepatogastroenterology. 2003;50(52):1133–5. PubMed PMID: 12845997.
Pradka SP, Trankiem CT, Ricotta JJ. Pylephlebitis and acute mesenteric ischemia in a young man with inherited thrombophilia and suspected foodborne illness. Journal of Vascular Surgery. 2012 Jun;55(6):1769–72. doi:10.1016/j.jvs.2011.12.055
Hartpence J, Woolf A. Pylephlebitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2026 Mar 4]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK563246/ PubMed PMID: 33085393.
Saxena R, Adolph M, Ziegler JR, Murphy W, Rutecki GW. Pylephlebitis: a case report and review of outcome in the antibiotic era. Am J Gastroenterol. 1996 Jun;91(6):1251–3. PubMed PMID: 8651182.
Plemmons RM, Dooley DP, Longfield RN. Septic Thrombophlebitis of the Portal Vein (Pylephlebitis): Diagnosis and Management in the Modern Era. Clinical Infectious Diseases. 1995 Nov 1;21(5):1114–20. doi:10.1093/clinids/21.5.1114
Referanslar
Rühl H, Reda S. Management of Splanchnic Venous Thrombosis: An Update. Hamostaseologie. 2026 Feb;46(01):071–7. doi:10.1055/a-2749-6835
Pan J, Wang L, Gao F, An Y, Yin Y, Guo X, et al. Epidemiology of portal vein thrombosis in liver cirrhosis: A systematic review and meta-analysis. Eur J Intern Med. 2022 Oct;104:21–32. doi:10.1016/j.ejim.2022.05.032 PubMed PMID: 35688747.
Nery F, Chevret S, Condat B, de Raucourt E, Boudaoud L, Rautou PE, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study. Hepatology. 2015 Feb;61(2):660–7. doi:10.1002/hep.27546 PubMed PMID: 25284616.
Fusaro L, Di Bella S, Martingano P, Crocè LS, Giuffrè M. Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis. Diagnostics (Basel). 2023 Jan 25;13(3):429. doi:10.3390/diagnostics13030429 PubMed PMID: 36766534; PubMed Central PMCID: PMC9914785.
Choudhry AJ, Baghdadi YMK, Amr MA, Alzghari MJ, Jenkins DH, Zielinski MD. Pylephlebitis: a Review of 95 Cases. J Gastrointest Surg. 2016 Mar;20(3):656–61. doi:10.1007/s11605-015-2875-3 PubMed PMID: 26160320; PubMed Central PMCID: PMC4882085.
Naymagon L, Tremblay D, Schiano T, Mascarenhas J. The role of anticoagulation in pylephlebitis: a retrospective examination of characteristics and outcomes. J Thromb Thrombolysis. 2020 Feb;49(2):325–31. doi:10.1007/s11239-019-01949-z PubMed PMID: 31493290.
Harris M, Thachil J. Portal vein thrombosis – a primer for the general physician. Clinical Medicine. 2017 Jun;17(3):212–9. doi:10.7861/clinmedicine.17-3-212
Simonetto DA, Singal AK, Garcia-Tsao G, Caldwell SH, Ahn J, Kamath PS. ACG Clinical Guideline: Disorders of the Hepatic and Mesenteric Circulation. Am J Gastroenterol. 2020 Jan;115(1):18–40. doi:10.14309/ajg.0000000000000486
Elkrief L, Hernandez-Gea V, Senzolo M, Albillos A, Baiges A, Berzigotti A, et al. Portal vein thrombosis: diagnosis, management, and endpoints for future clinical studies. The Lancet Gastroenterology & Hepatology. 2024 Sep;9(9):859–83. doi:10.1016/S2468-1253(24)00155-9
Davis JPE, Lim JK, Francis FF, Ahn J. AGA Clinical Practice Update on Management of Portal Vein Thrombosis in Patients With Cirrhosis: Expert Review. Gastroenterology. 2025 Feb;168(2):396-404.e1. doi:10.1053/j.gastro.2024.10.038
Francoz C, Valla D, Durand F. Portal vein thrombosis, cirrhosis, and liver transplantation. Journal of Hepatology. 2012 Jul;57(1):203–12. doi:10.1016/j.jhep.2011.12.034
Amitrano L, Anna Guardascione M, Brancaccio V, Margaglione M, Manguso F, Iannaccone L, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. Journal of Hepatology. 2004 May;40(5):736–41. doi:10.1016/j.jhep.2004.01.001
Harding DJ, Perera MTP, Chen F, Olliff S, Tripathi D. Portal vein thrombosis in cirrhosis: Controversies and latest developments. WJG. 2015 Jun 14;21(22):6769–84. doi:10.3748/wjg.v21.i22.6769
Yerdel MA, Gunson B, Mirza D, Karayalçin K, Olliff S, Buckels J, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000 May 15;69(9):1873–81. doi:10.1097/00007890-200005150-00023 PubMed PMID: 10830225.
Tripodi A, Mannucci PM. The Coagulopathy of Chronic Liver Disease. N Engl J Med. 2011 Jul 14;365(2):147–56. doi:10.1056/NEJMra1011170
Turon F, Driever EG, Baiges A, Cerda E, García-Criado Á, Gilabert R, et al. Predicting portal thrombosis in cirrhosis: A prospective study of clinical, ultrasonographic and hemostatic factors. J Hepatol. 2021 Dec;75(6):1367–76. doi:10.1016/j.jhep.2021.07.020 PubMed PMID: 34333101.
Singal AK, Kamath PS, Tefferi A. Mesenteric Venous Thrombosis. Mayo Clinic Proceedings. 2013 Mar;88(3):285–94. doi:10.1016/j.mayocp.2013.01.012
Stefano VD, Qi X, Betti S, Rossi E. Splanchnic vein thrombosis and myeloproliferative neoplasms: molecular-driven diagnosis and long-term treatment. Thromb Haemost. 2016 Mar;115(02):240–9. doi:10.1160/th15-04-0326
Greenfield G, McMullin MF. Splanchnic venous thrombosis in JAK2 V617F mutation positive myeloproliferative neoplasms – long term follow-up of a regional case series. Thrombosis J. 2018 Dec;16(1):33. doi:10.1186/s12959-018-0187-z
Northup PG, Garcia-Pagan JC, Garcia-Tsao G, Intagliata NM, Superina RA, Roberts LN, et al. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73(1):366–413. doi:10.1002/hep.31646 PubMed PMID: 33219529.
Hernández-Gea V, De Gottardi A, Leebeek FWG, Rautou PE, Salem R, Garcia-Pagan JC. Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis. Journal of Hepatology. 2019 Jul;71(1):175–99. doi:10.1016/j.jhep.2019.02.015
Turon F, Cervantes F, Colomer D, Baiges A, Hernández-Gea V, Garcia-Pagán JC. Role of calreticulin mutations in the aetiological diagnosis of splanchnic vein thrombosis. Journal of Hepatology. 2015 Jan;62(1):72–4. doi:10.1016/j.jhep.2014.08.032
Gioia S, Nardelli S, Ridola L, d’Amati G, Riggio O. Is porto sinusoidal vascular disease to be actively searched in patients with portal vein thrombosis? WJH. 2019 Aug 27;11(8):613–8. doi:10.4254/wjh.v11.i8.613
Gil-Lopez F, Rios-Olais FA, Mercado LA, Harnois DM. Portal Vein Thrombosis in Patients Without Cirrhosis: Current Practical Approaches and Treatment Strategies. Diagnostics. 2025 Mar 13;15(6):721. doi:10.3390/diagnostics15060721
Zocco MA, Di Stasio E, De Cristofaro R, Novi M, Ainora ME, Ponziani F, et al. Thrombotic risk factors in patients with liver cirrhosis: Correlation with MELD scoring system and portal vein thrombosis development. Journal of Hepatology. 2009 Oct;51(4):682–9. doi:10.1016/j.jhep.2009.03.013
Rautou PE, Moga L, Hernandez-Gea V, Ageno W, Darwish Murad S, Garcia-Pagan JC, et al. EASL Clinical Practice Guidelines on vascular diseases of the liver. Journal of Hepatology. 2026 Feb;84(2):399–456. doi:10.1016/j.jhep.2025.08.001
Yuan C, Guo K, Wang N, Wang H, Wu S, Zhu Y, et al. Successful management of acute superior mesenteric infarction caused by extensive portal-mesenteric venous thrombosis: a case report. AME Case Rep. 2026;10:20. doi:10.21037/acr-2025-249 PubMed PMID: 41676215; PubMed Central PMCID: PMC12885853.
Lee H, Han YH, Chung JW, Kim KO, Kwon KA, Kim JH. Upper gastrointestinal bleeding with duodenal varix: A case report. World J Clin Cases. 2026 Feb 6;14(4):116648. doi:10.12998/wjcc.v14.i4.116648 PubMed PMID: 41695764; PubMed Central PMCID: PMC12897486.
de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959–74. doi:10.1016/j.jhep.2021.12.022 PubMed PMID: 35120736; PubMed Central PMCID: PMC11090185.
De Gaetano AM, Lafortune M, Patriquin H, De Franco A, Aubin B, Paradis K. Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic collateral circulation detected with Doppler sonography. AJR Am J Roentgenol. 1995 Nov;165(5):1151–5. doi:10.2214/ajr.165.5.7572494 PubMed PMID: 7572494.
Chandok N, Watt KDS. Pain Management in the Cirrhotic Patient: The Clinical Challenge. Mayo Clinic Proceedings. 2010 May;85(5):451–8. doi:10.4065/mcp.2009.0534
Swetz KM, Carey EC, Rho RH, Mauck WD, Whitford KJ, Moynihan TJ, et al. Safe Use of Opioids to Manage Pain in Patients With Cirrhosis. Mayo Clinic Proceedings. 2010 Oct;85(10):959. doi:10.4065/mcp.2010.0294
Kasper DL, Sahani D, Misdraji J. Case 25-2005: A 40-Year-Old Man with Prolonged Fever and Weight Loss. Cabot RC, Harris NL, Shepard JAO, Ebeling SH, Ellender SM, Peters CC, editors. N Engl J Med. 2005 Aug 18;353(7):713–22. doi:10.1056/NEJMcpc059020
Kanellopoulou T, Alexopoulou A, Theodossiades G, Koskinas J, Archimandritis AJ. Pylephlebitis: An overview of non-cirrhotic cases and factors related to outcome. Scandinavian Journal of Infectious Diseases. 2010 Dec;42(11–12):804–11. doi:10.3109/00365548.2010.508464
Osler W. Case of Obliteration of the Portal Vein (Pylephlebitis Adhesiva). J Anat Physiol. 1882 Jan;16(Pt 2):208–16. PubMed PMID: 17231426; PubMed Central PMCID: PMC1310058.
Takahashi H, Sakata I, Adachi Y. Treatment of portal vein septic thrombosis by infusion of antibiotics and an antifungal agent into portal vein and superior mesenteric artery: a case report. Hepatogastroenterology. 2003;50(52):1133–5. PubMed PMID: 12845997.
Pradka SP, Trankiem CT, Ricotta JJ. Pylephlebitis and acute mesenteric ischemia in a young man with inherited thrombophilia and suspected foodborne illness. Journal of Vascular Surgery. 2012 Jun;55(6):1769–72. doi:10.1016/j.jvs.2011.12.055
Hartpence J, Woolf A. Pylephlebitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2026 Mar 4]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK563246/ PubMed PMID: 33085393.
Saxena R, Adolph M, Ziegler JR, Murphy W, Rutecki GW. Pylephlebitis: a case report and review of outcome in the antibiotic era. Am J Gastroenterol. 1996 Jun;91(6):1251–3. PubMed PMID: 8651182.
Plemmons RM, Dooley DP, Longfield RN. Septic Thrombophlebitis of the Portal Vein (Pylephlebitis): Diagnosis and Management in the Modern Era. Clinical Infectious Diseases. 1995 Nov 1;21(5):1114–20. doi:10.1093/clinids/21.5.1114
