Septic pylephlebitis with detection of portal venous gas:: a rare complication of left colonic diverticulitis

Pylephlebitis, septic thrombosis of the portal vein and its branches, is an infrequent complication of intra-abdominal inflammatory processes which may lead to thrombosis of the portal vein or to liver abscesses. Air in the portal venous system usually predicts a fatal outcome. The survival rate calculated in all reported cases is less than 25%. It is important to detect portal venous gas early. In detection of portal venous gas, ultrasound and computed tomography are more sensitive than plain radiographs. Pylephlebitis used to be a dreaded complication of appendicitis, but the incidence of this disease has greatly declined since the development of antibiotics and modern surgical techniques. We present two cases of pyrephlebitis associated with gas in the portal vein as a result of left colonic diverticulitis treated by bowel resection. In spite of the occurrence of portal venous gas, the outcome may be favourable if this disease undergoes prompt surgical treatment.