Gas in the Inferior Mesenteric Vein – successful non operative management of a rare complication of diverticulitis

Gas in the Inferior Mesenteric Vein – successful non operative management of a rare complication of diverticulitis

Williams, Ryan1; Chuang,Tzu-Yi1; Choy, Kay Tai2; Ranasinghe, Saranga 1

1Department of General Surgery, Redland Hospital, Cleveland, Queensland, Australia
2Department of General Surgery, Hervey Bay Hospital, Urraween, Queensland, Australia

Septic phlebitis (also known as pyelephlebitis) because of diverticulitis is a rare but important complication. Many previous cases have mandated urgent surgical management for fear of further deterioration. This case report details one of the first cases where septic phlebitis was successfully managed conservatively, and details important clinical lessons clinicians should be aware of.

Keywords: Septic phlebitis, pyelephlebitis, diverticulitis, inferior mesenteric vein (IMV) gas.

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Williams, Ryan; Chuang,Tzu-Yi; Choy, Kay Tai; Ranasinghe, Saranga. Gas in the Inferior Mesenteric Vein – successful non operative management of a rare complication of diverticulitis. International Journal of Case Reports, 2021, 5:232. DOI: 10.28933/ijcr-2021-07-1005


1. Falkowski AL, Cathomas G, Zerz A, Rasch H, Tarr PE. Pylephlebitis of a variant mesenteric vein complicating sigmoid diverticulitis. J Radiol Case Rep. 2014;8[2]:37-45.
2. Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M. Diverticulitis: a comprehensive review with usual and unusual complications. Insights into imaging. 2017;8[1]:19-27.
3. Kaewlai R, Nazinitsky KJ. Acute colonic diverticulitis in a community-based hospital: CT evaluation in 138 patients. Emerg Radiol. 2007;13[4]:171-9.
4. Rose J, Khoubyari R, McClenathan J. Diverticulitis as a cause of septic thrombophlebitis: A literature review. International J Case Reports and Images [IJCRI]. 2010:28-33.
5. Sellner F, Sobhian B, Baur M, Sellner S, Horvath B, Mostegel M, et al. Intermittent hepatic portal vein gas complicating diverticulitis–a case report and literature review. International Journal of Colorectal Disease. 2007;22[11]:1395-9.
6. Choudhry AJ, Baghdadi YMK, Amr MA, Alzghari MJ, Jenkins DH, Zielinski MD. Pylephlebitis: a Review of 95 Cases. Journal of Gastrointestinal Surgery. 2016;20[3]:656-61.
7. Bazan F, Busto M. Pylephlebitis as a Complication of Diverticulitis. The New England Journal of Medicine. 2015;373[23]:2270.
8. Sjöbring U, Ringdahl U, Ruggeri ZM. Induction of platelet thrombi by bacteria and antibodies. Blood. 2002;100[13]:4470-7.
9. 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;42[11-12]:804-11.
10. Zia A, Sohal S, Costas C. Pylephlebitis: A Case of Inferior Mesenteric Vein Thrombophlebitis in a Patient with Acute Sigmoid Diverticulitis—A Case Report and Clinical Management Review. Case Reports in Infectious Diseases. 2019;2019:4.
11. Zielke A, Hasse C, Nies C, Rothmund M. Hepatic-portal venous gas in acute colonic diverticulitis. Surgical endoscopy. 1998;12[3]:278-80.
12. Plemmons RM, Dooley DP, Longfield RN. Septic thrombophlebitis of the portal vein [pylephlebitis]: diagnosis and management in the modern era. Clin Infect Dis. 1995;21[5]:1114-20.
13. Belhassen-García M, Gomez-Munuera M, Pardo-Lledias J, Velasco-Tirado V, Perez-Persona E, Galindo-Perez I, et al. Pylephlebitis: Incidence and prognosis in a tertiary hospital. Enfermedades Infecciosas y Microbiología Clínica. 2014;32[6]:350-4.
14. Draghetti MJ, Salvo AF. Gas in the mesenteric veins as a nonfatal complication of diverticulitis. Diseases of the Colon & Rectum. 1999;42[11]:1497-8.

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