[Phylephebitis due to diverticulitis].

A case of a 52 year-old-male, with past medical history of renoureteral crisis and recurrent episodes of abdominal pain, is presented. The patient presented to the Emergency Department with abdominal pain (similar to previous episodes), fever and abnormal liver function test (marked elevation of gammaglutamyltranspeptidase and alkaline phosphatase). An abdominal ultrasound was performed showing hepatomegaly, and enlarged spleen and an echogenic material that suggested a thrombosis. A CT scan confirmed the thrombosis of the inferior mesenteric vein extending up to the splenic vein and the portal vein. It also showed a large number of diverticulum. Surgery was performed in order to rule out an acute diverticulitis. A phylephlebitis, infective suppurative thrombosis of the portal vein and its branches (inferior mesenteric vein and splenic vein) was found due to an acute diverticulitis with neither perforation nor abscess. A ligature of the inferior mesenteric vein and a Hartmann procedure with resection of the diseased colon, and end colostomy and creation of a rectal stump, were performed. A favourable outcome was obtained with antibiotics and anticoagulation. Some aspects of the aetiology, symptoms, diagnosis and treatment of this unusual complication of diverticulitis are also presented.