Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2021; 9(23): 6768-6774
Published online Aug 16, 2021. doi: 10.12998/wjcc.v9.i23.6768
Pylephlebitis — a rare complication of a fish bone migration mimicking metastatic pancreatic cancer: A case report
Sofia Bezerra, Nuno J França, Firmo Mineiro, Germano Capela, Cristina Duarte, António Ribeiro Mendes
Sofia Bezerra, Nuno J França, Firmo Mineiro, Germano Capela, Cristina Duarte, António Ribeiro Mendes, Department of Surgery, Centro Hospitalar do Médio Tejo, Tomar 2304-909, Portugal
Author contributions: Bezerra S and França NJ contributed equally to this case, both wrote and revised the text; Mineiro F, Capela G, Duarte C and Mendes AR contributed equally in this case report; all were part of the clinical team that treated the patient and all commented the text.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interests exist to any of the authors.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nuno J França, MD, Doctor, Department of Surgery, Centro Hospitalar do Médio Tejo, Avenida Maria de Lourdes de Mello e Castro, Tomar 2304-909, Portugal. nuno.franca@chmt.min-saude.pt
Received: November 5, 2020
Peer-review started: November 5, 2020
First decision: December 13, 2020
Revised: December 26, 2020
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: August 16, 2021
Processing time: 273 Days and 0.1 Hours
Abstract
BACKGROUND

Pylephlebitis is a rare condition, poorly recognized by clinicians and with few references. In this case, the clinical appearance resembled the clinical course of a pancreatic cancer and was originated by the ingestion of a fish bone, making the case more interesting and rare.

CASE SUMMARY

A 79-year-old female presented to the emergency department with fever, loss of appetite and jaundice. Tenderness in the right upper quadrant was present. Inflammation marker were high. A computed tomography (CT) scan revealed gallstones and aspects compatible with acute pancreatitis. The patient was admitted to surgery ward and has her condition aggravated. A magnetic resonance revealed multifocal liver lesions. Later, a cholangiopancreatography and an endoscopic ultrasound (US) were able to diagnose the condition. Specific treatment was implemented and the patient made a complete recovery.

CONCLUSION

In conclusion, this case report demonstrates for the first time the diagnosis of an unusual case of pylephlebitis complicated by the migration of a fish bone, mimicking metastatic pancreatic cancer. Clinical presentation and traditional imaging studies, such as transabdominal US and CT, remain the standard for diagnosing this condition.

Keywords: Pylephlebitis; Portal vein thrombosis; Abdominal infection; Fish bone; Pancreatic cancer; Case report

Core Tip: Pylephlebitis refers to septic thrombophlebitis of the portal vein or its branches, which is a rare and potentially lethal complication of an intra-abdominal infection. A female patient was studied clinical and imagiologically and was diagnosed with pylephlebitis arising from an infection of a fish bone migration. This condition is an extremely rare cause of pylephlebitis and, in this case, mimicked the clinic of a metastatic pancreatic cancer.