Diverticulitis-associated pylephlebitis of the inferior mesenteric vein: successful conservative management of a rare complication of a common acute surgical diagnosis.

Pylephlebitis of the inferior mesenteric vein is an uncommon complication of sigmoid diverticulitis. A 46-year-old man presented with abdominal pain and features of sepsis. Blood cultures confirmed Bacteroides fragilis bacteraemia, and computed tomography imaging confirmed diverticulitis of the sigmoid colon, complicated by thrombosis of the inferior mesenteric vein. He was managed successfully with empiric antibiotic cover and anticoagulation, before transitioning to ongoing warfarin therapy long term. Treatment for pylephlebitis requires broad-spectrum antibiotic therapy. Anticoagulation is initiated on a case-by-case basis, as no literature consensus exists regarding its utility. Some reports demonstrate a lower rate of thrombotic and septic sequelae in cases where anticoagulation is used for treatment. Surgical treatment remains commonplace in cases of diverticulitis complicated by pylephlebitis. This case describes the presentation and successful management of a case of diverticulitis-associated pylephlebitis, with antibiotic and anticoagulation therapy alone.