Pyogenic Hepatic Abscess Research Articles

S4039 Multiple Large Pyogenic Hepatic Abscesses in the Setting of Stage IV Pancreatic Adenocarcinoma With Transpapillary Drainage Assisted by IR-Guided Biliary Rendezvous Procedure

S4039 Multiple Large Pyogenic Hepatic Abscesses in the Setting of Stage IV Pancreatic Adenocarcinoma With Transpapillary Drainage Assisted by IR-Guided Biliary Rendezvous Procedure

The Pyogenic Hepatic Abscess: To Drain or not to Drain, that is the Question. Clinical Presentation and Outcome Evaluation after Conservative and Invasive Treatment

Background: Pyogenic hepatic abscess (PHA) is an uncommon infectious disease of the liver that should represents a life-threatening condition if not correctly diagnosed and managed. Nowadays there are not precise indications and clear evidences on the best therapeutic approach and on the superiority of a treatment. Methods: Patients with diagnosis of PHA admitted at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2010 and December 2022 were identified in a prospective database. Among the demographic, epidemiological and clinical data collected we included the therapeutic choices – antibiotic treatment, image guided percutaneous drainage and surgical operation – and their effect in terms of healing time, treatment failure and time of hospitalization. Results: Patients with single abscesses treated with antibiotics have significant high healing time (p=0.0001) and in-hospital time (p=0.0001) and no differences in treatment failure than patients treated with invasive techniques. Patients that underwent surgical operation have significant higher healing time than percutaneous group (p=0.002) such as higher mean hospital stay (p=0.03 for abscesses <5 cm and p=0.02 for abscesses larger than 5 cm). The last, the percutaneous approach shows a failure rate significantly higher than the surgical procedure (p=0.009 for abscesses <5 cm and p=0.001 for abscesses larger than 5 cm). Conclusions: The study proposed showed the antibiotic therapy is the first line treatment and should first empirically and then directly modified on specimen culture results. Image guided percutaneous drainage should be considered when the antibiotic therapy alone is not sufficient or as bridge to surgery if surgical indications are proven.

Case Report: Abdominal variant of Lemierre’s syndrome

Lemierre's syndrome is a rare condition characterized by Fusobacterium bacteremia from an oropharyngeal source with septic emboli causing internal jugular vein (IVJ) thrombophlebitis in an otherwise young and healthy host. Rare variants of this rare disease have been described impacting the gastrointestinal, pulmonary, neurologic, musculoskeletal, soft tissue, and genitourinary systems. We discuss a case of an abdominal variant of Lemierre's syndrome. An otherwise young and healthy male presented with two pyogenic hepatic abscesses, Fusobacterium necrophorum bacteremia, and local hepatic venous thrombosis. The hepatic abscesses were percutaneously drained, he received broad-spectrum antibiotics and therapeutic-level anticoagulation, and he showed marked clinical improvement over a six-day hospital course. He was discharged with four weeks of daily oral and intravenous (IV) antibiotics, six months of direct oral anticoagulation, and close follow up. Clinicians should consider thrombophlebitis in more anatomical locations than the IVJ which is found classically in Lemierre’s syndrome in the setting of Fusobacterium bacteremia.

Pyogenic Hepatic Abscess in an Immunocompetent Patient With Poor Oral Health and COVID-19 Infection.

Pyogenic hepatic abscess (PHA) is a collection of pus in the liver caused by bacterial infection of the liver parenchyma. PHA is more common in immunosuppressed individuals and those with diabetes mellitus, cancer, and liver transplant. We present a rare case of PHA with Fusobacterium nucleatum in an immunocompetent patient with poor oral health, history of diverticulitis, and recent COVID-19 infection whose only symptoms were chest pain and a 4-week history of fever and malaise. The source of infection in this patient was likely dental caries and periodontal disease, with COVID-19 infection playing a role as a red herring in this patient's disease progression, delaying diagnosis. Diagnosis and treatment of PHA must be prompt with drainage and empiric anaerobic coverage followed by a more tailored antibiotic regimen if indicated by culture and further drainage if indicated by computed tomography.

Pyogenic Liver Abscess Caused by Acute Appendicitis: A Case Report

Pyogenic hepatic abscesses represent a pathology whose prevalence has increased in recent years. In the past, surgical treatment of pyogenic liver abscesses was the gold standard. Nowadays, percutaneous drainage has become the first-line treatment. We report the case of a pyogenic liver abscess caused by acute appendicitis. Our management consisted of a combined treatment: percutaneous drainage of the abscess followed by appendectomy.

Pediatric Hepatic Abscess: A Ten-year Review of the Features and Outcome at the Philippine General Hospital

Objective. Hepatic abscess is a rare childhood infection with incidence of 1 to 140 per 105 admissions. It has signs and symptoms that mimic other liver diseases. This study determined the clinical, biochemical, microbiologic and imaging features and outcome of children diagnosed with hepatic abscess at a tertiary hospital in Manila.
 Method. We conducted a review of medical records of admitted patients aged ≤18 years diagnosed with hepatic abscess in a tertiary referral center from 2007–2018. A diagnosis was confirmed if with (1) fever; (2) imaging study of solitary or multiple hepatic focus; AND (3) at least one more sign or symptom. We computed for mean (SD) for continuous variables or n (%) for categorical variables.
 Result. We included 40 patients out of 559, 583 pediatric admissions during the study period (0.007%), with a mean age of 8 years (SD 6.5), and 57% of whom were males. Thirty-seven (92%) were probable pyogenic in etiology, while three were tuberculous abscess. The most common signs and symptoms were fever (100%), abdominal mass (31%), abdominal distension (34%) and weight loss (31%). Majority had anemia (63%) and leukocytosis (89%). The most common imaging finding was a solitary mass (58%) with right lobe (80%) involvement. Nine abscess aspirates yielded Staphylococcus aureus (3), Mycobacterium tuberculosis (3), Klebsiella pneumoniae (1) and no growth (2). All patients were medically treated but eight also required percutaneous/surgical drainage. Majority (36) were discharged improved; four were improving but left before treatment completion.
 Conclusion. Majority had pyogenic hepatic abscess, presenting with non-specific clinical and laboratory features. Most abscess were solitary and involved the right lobe. Limited abscess aspirates yielded Staphylococcus aureus and Mycobacterium tuberculosis. Prognosis is favorable with treatment.

Abscesso hepático piogênico por Pseudomonas aeruginosa em pré-escolar

Pyogenic hepatic abscess is a purulent collection secondary to bacterial infection in the hepatic parenchyma. Is relatively rare in general population, around 1.1 to 2.3/100.000 inhabitant, with mortality between 5.6-80%. In this study, we report the case of a preschool, male, with fourteen days of fever, abdominal distention, pallor, Torres-Homem sign, periumbilical hypertimpanism and hepatomegaly. He arrived with leukocytosis/neutrophilia, high reactive-C protein, normochromic/normocitic anemia, increased liver and canalicular enzymes, in addition to alteration of coagulation tests. Ultrasonography and abdominal tomography showed heterogeneous collections of irregular contours and inaccurate limits in segments IV, V, VII and VIII. Gallbladder of thickened walls with hyperechogenic image measuring 0.8cm. The initial treatment consisted of the association of ampicillin and sulbactam associated with metronidazol and transcutaneous drainage of the abscess guided by ultrasonography. With the positive culture of the abscess material for Pseudomonas aeruginosa, ciprofloxacin began and the performance of weekly abdominal ultrasound. He was discharged after ultrasonography of abdomen without abscesses. The triad of pyogenic hepatic abscess encompasses abdominal pain, intermittent fever and hepatomegaly. They are usually associated with predisposing factors from immunosuppression to biliary pathway pathologies and neoplasms. Percutaneous drainage guided by CT or US is currently first-line treatment. Even though it is rare, HA should be among the differential diagnosis options of abdominal pain and intermittent fever.

S2770 Pyogenic Hepatic Abscess Caused by Cronobacter Sakazakii – A Case Report and Review of Literature

S2770 Pyogenic Hepatic Abscess Caused by Cronobacter Sakazakii – A Case Report and Review of Literature

S1505 Choledochoduodenal Fistula: An Old Complication of Choledocholithiasis With a New Presentation

INTRODUCTION: Enterobiliary fistulas were first described in 1654 with 68% of cases occurring between the gallbladder wall and duodenum. Choledochoduodenal fistulas (CDF) are less common (8.6%) and most are asymptomatic. This case highlights a rare presentation of pneumobilia, cholangitis, and pyogenic hepatic abscesses in a patient with CDF. CASE DESCRIPTION/METHODS: A 68 year old male with a past medical history of diabetes presented with rigors and fevers for one day. He denied abdominal pain, history of gallbladder disease, or recent travel history. Vitals signs were notable for BP 70/40, HR 110, T 101 F. Physical exam was remarkable for scleral icterus, but no abdominal tenderness or altered mentation. Lab results revealed WBC 31,000, creatinine 3.94, total bilirubin 9.6, direct bilirubin 7.9, AST 117, ALT 94, ALP 484, lactate 7.4, and positive blood cultures for Escherichia coli. CT abdomen without contrast revealed marked intra and extrahepatic bile duct dilatation with multiple focal densities identified in the liver and pneumobilia at the level of the distal common bile duct (CBD) (Figure 1). Antibiotics were started and he underwent ERCP which revealed a suprapapillary CDF with significant stone burden and pus in the CBD. Sphincterotomy was performed to the level of the CDF. Many stones were removed and two plastic stents were placed to ensure drainage. Follow up liver MRI revealed numerous hepatic abscesses. The patient’s vitals and laboratory markers improved with antibiotics, and he was scheduled for follow up outpatient ERCP to complete endotherapy. DISCUSSION: CDF can be caused by choledocholithiasis, duodenal ulcers, tumor invasion, or post-cholecystectomy complications. Most cases of CDF are asymptomatic and incidentally detected. However in the subset of symptomatic cases, cholangitis is the most common presentation. Furthermore, chronic cholangitis due to reflux of duodenal contents with bacterial flora may cause hepatic abscesses, though this has only been documented in case reports. Diagnosis can be achieved by ERCP with direct visualization of CDF and successful cholangiography through the papilla and fistula orifice. With few studies investigating this entity, proposed treatment options are conflicting. Some advocate for less invasive measures, such as endoscopic interventions for asymptomatic patients or distal CDF. Others regard CDF as a biliary abnormality that predisposes to recurrent infections and increases the risk for malignancy, and thus advocate for surgical management.Figure 1.: This sagittal view of a noncontrast CT abdomen/pelvis delineates hepatic abscesses, pneumobilia at the level of the choledochoduodenal fistula, and dilated intra and extrahepatic bile ducts.

Thrombectomy for right atrial thrombosis complicating a pyogenic liver abscess

Vascular complications from a liver abscess are rare but life-threatening. Herein, we report the case of a man in his 40s with a pyogenic hepatic abscess complicated by an inferior vena caval thrombus extending to the right atrium. His presenting complaint was a high fever. Blood tests revealed elevated inflammatory markers and liver enzymes. An abdominal CT demonstrated a 10cm abscess in the right hepatic lobe. A blood culture grew Streptococcus intermedius, which was sensitive to ampicillin sulbactam. He was diagnosed with a pyogenic liver abscess and treated with metronidazole and ampicillin sulbactam. Three days following admission, an abdominal CT scan revealed the thrombus extending from the liver abscess into the right atrium. He underwent thrombectomy and received antibiotic therapy. Postoperatively, abdominal ultrasound revealed a significant decrease in the size of the hepatic abscess. The patient was discharged in good condition on the 46th day of hospitalization. When encountering a hepatic abscess, it is important to consider that it may be associated with a thrombus extending from the inferior vena cava into right atrium.

Laparoscopic Treatment of Hepatic Abscess Caused by an Ingested Foreign Body

Pyogenic hepatic abscess caused by an ingested foreign body is extremely uncommon, and reports on the laparoscopic treatment for it are very rare. We report here on a case of hepatic abscess caused by an ingested chicken bone which was treated with a laparoscopic approach. A 61-year-old man visited an emergency room with the chief complaints of high fever. He was diagnosed with pyogenic liver abscess that contained a sharp calcified foreign body seen on a CT-scan. At first, percutaneous transhepatic drainage of the abscess was performed to achieve recovery of the patient’s condition. Subsequent laparoscopic exploration found and removed the foreign body in the lesser sac. The foreign body turned out to be an ingested chicken bone. The patient was discharged on the 10th day after surgery.

A 2-year-old with a hepatic abscess secondary to an ascending retrocecal appendicitis: case report and review of the literature

BackgroundDiagnosing appendicitis within the pediatric population can be challenging, whether it be a neonate with irritability or a toddler with flank pain. Symptoms may mimic a viral illness, constipation, urinary tract infection, or intussusception, all of which are more common in this age group when compared with appendicitis. While a ruptured appendicitis can result in an intra-abdominal abscess, peritonitis, and/or shock, the development of a pyogenic hepatic abscess is extremely rare.Case presentationWe present the case of a 2-year-old male who initially presented to the emergency department (ED) with fever and non-specific abdominal pain and was diagnosed with a urinary tract infection (UTI). He returned to the ED days later with rigors, worsening abdominal pain, and was diagnosed with a pyogenic hepatic abscess secondary to an ascending retrocecal appendicitis. In our patient, he did not just have a UTI with cultures growing Escherichia coli, but a hepatic abscess that was polymicrobial. He was started on broad-spectrum antibiotics and a 10 French pigtail catheter was placed. The patient was ultimately discharged on day 8 with continued antibiotics. After his antibiotic course, he underwent an elective laparoscopy appendectomy and is currently doing well post-operatively.ConclusionOur case report illustrates the significance in identifying atypical features of appendicitis, broadening the differential of non-specific abdominal pain in pediatric patients, and depending on the clinical situation, ruling out other potential intra-abdominal infections even in the presence of a true urinary tract infection.

Minimally Invasive Surgical Management as Effective First-Line Treatment of Large Pyogenic Hepatic Abscesses

Management of pyogenic hepatic abscesses (PHA) varies among surgeons and institutions. Recent studies have advocated for first-line percutaneous drainage (PD) of all accessible hepatic abscesses, with surgery reserved as rescue only. Our study aimed to internally validate an established multimodal algorithm for PHA at a high-volume hepatopancreatobiliary center. Patients treated by the hepatopancreatobiliary service for PHA were retrospectively reviewed from 2008 through 2018. The algorithm defined intended first-line treatment as antibiotics for type I abscesses (<3 cm), PD for type II (≥3, unilocular), and surgical intervention (minimally invasive drainage or resection, when possible) for type III (≥3 cm, multilocular). Outcomes were compared between patients who received first-line treatment following the algorithm versus alternate therapy. Of 330 patients with PHA, 201 met inclusion criteria. Type III abscesses had significantly lower failure following algorithmic approach with surgery compared with PD (4% vs 28%, P = 0.018). Type II abscesses failed first-line PD in 27 per cent (13/48) with 11 patients requiring surgical rescue, whereas first-line surgery failed in only 13 per cent (2/15). No deaths occurred after any surgical intervention, and there was no statistical difference in major complications between first-line surgical intervention and PD for type II or III abscesses. These results support the algorithmic approach and demonstrate that minimally invasive surgical intervention is a safe and effective modality for large PHA. We recommend that select patients with large, complex abscesses should be considered for a first-line minimally invasive surgical approach depending on surgical experience and available resources.

50 Years Ago in The Journal of Pediatrics: Pyogenic Hepatic Abscess in Infancy and Childhood

50 Years Ago in The Journal of Pediatrics: Pyogenic Hepatic Abscess in Infancy and Childhood

Analysis of a multimodal, algorithmic approach for the treatment of liver abscesses

Background: Management of pyogenic hepatic abscesses (PLA) often requires multimodal treatment strategies but there is wide variation in treatment pathways between surgeons and across healthcare systems. Recent literature has proposed that percutaneous drainage should be performed as a first-attempt in all amenable abscesses with surgery reserved as a rescue method. This study is a retrospective review and internal validation of a multimodal treatment algorithm for PLA at a high-volume hepatopancreatobiliary center of excellence. Methods: Retrospective analysis was performed on patients with PLA between 2008 and 2018 at our institution. Patients with recent hepatic trauma or surgery with subsequent abscess, or cholecystectomy for cholecystitis with unroofing of adjacent hepatic abscess were excluded. An established institutional algorithm was used to assign intended first-line treatment as antibiotics alone for Type I abscesses (small 3 cm, multilocular). Failure of initial treatment was defined as persistent or recurrent abscess on imaging requiring repeated or escalated treatment with drainage or surgery. Outcomes were compared between patients with first-line treatment following the algorithm versus patients treated with alternate first-line therapy. Results: During the study period 300 patients underwent treatment for pyogenic liver abscesses. Eighty-two were excluded for penetrating liver trauma (n = 15), recent hepatic surgery (n = 39), or unroofing of abscess at cholecystectomy (n = 28), leaving 219 patients eligible for inclusion. First-line treatment was delivered through antibiotics alone for 47 patients (21.5%), percutaneous drainage with antibiotics for 120 patients (54.8%), and surgical intervention for 52 patients (23.7%). Large multilocular abscesses (Type III) had significantly lower failure rates following algorithmic approach with primary surgical treatment (3/32) compared to first-line antibiotics or percutaneous drainage (24/80) (9.3% versus 30.0%, p=0.021) with no 30-day mortalities for either group. Large unilocular abscesses (Type II) failed first-line percutaneous drainage in 25.5% (13/51), with 10 patients requiring escalation to surgery. Treatment of Type II abscesses with primary surgery rather than percutaneous drainage was successful in 88.2% (15/17) with no 30-day mortalities. Conclusion: Primary surgical intervention is highly successful in the treatment of large pyogenic liver abscesses. While antibiotic therapy remains the mainstay of treatment for small acute liver abscesses, in light of higher failure rates for percutaneous drainage we propose that surgical intervention should be considered for select patients with large complex abscesses as up-front definitive treatment.

HEPATECTOMY FOR PYOGENIC LIVER ABSCESS TREATMENT: EXCEPTION APPROACH?

ABSTRACTBackground: Percutaneous drainage for pyogenic liver abscess has been considered the gold-standard approach for the treatment on almost of the cases. However, when percutaneous drainage fails or even in some especial situations, as multiloculate abscess, lobe or segment surgical resection can solve infectious clinical condition. Aim: To report a series of patients who underwent hepatectomy for pyogenic liver abscess performed by a single surgical team. Methods: Eleven patients were operated with ages ranging from 45-73 years (mean and median 66 years). There were eight men and three women. The etiologies were: idiopathic (n=4), biliary (n=2), radiofrequency (n=2), direct extension (n=1), portal (n=1), and arterial (n=1). The mean lesion diameter was 9.27 cm (6-20 cm). Results: The mean operation length was 180 min (120-300). The mean intra-operative blood loss was 448 ml (50-1500). Surgical approaches were: right hepatectomy (n=4), left hepatectomy (n=3), left lateral sectioniectomy (n=1), right posterior sectioniectomy (n=2), resection of S8 (n=1), and S1 (n=1). Postoperative morbidity rate was 30%, while mortality was null. Median hospital stay was 18 days (5-45). The median follow-up period was 49 months (13-78). There was single lesion recurrence. Conclusion: Hepatectomy can be done as exception approach for pyogenic hepatic abscess treatment; it is a good therapeutic option in special situations.

Modern approaches to diagnosis and treatment of bacterial liver abscesses

Modern notions about etiology, pathogenesis and microbiological characteristics of bacterial liver abscesses are analyzed. Cholangiogenic abscess is a prevailing type among the incidences of liver abscesses. Today Klebsiella pneumoniae strains are the predominant cause of pyogenic hepatic abscess. Diagnosis of liver abscesses is based on a combination of clinical and laboratory findings and visualization survey methods. Success in the treatment of liver abscesses is provided by a multimodal approach, including sanation of purulent focus, rational antibacterial therapy and elimination of the main etiologic factor. Effective antibiotic therapy is based on the results of permanent microbiological monitoring of the abscess cavity, bile and blood contents. The question remains about what is the optimal time frame for antibiotic therapy. The main method of treatment of liver abscess is surgical. In the vast majority of cases, minimally invasive puncture-drainage under ultrasound or CT guidance proves to be an effective and sufficient method of treatment, regardless of the size, location and number of purulent foci. There is no consensus, however, on a differentiated choice of minimally invasive sanitation techniques, drainage periods and removal criteria in medical literature. An algorithm for treatment of cholangiogenic liver abscesses must include methods that ensure restoration of the bile ducts patency, relief of biliary hypertension and cholangitis. If the minimally invasive drainage techniques proves ineffective, as well as in cases of complicated abscess or presence of large sequesters in the destruction cavity, it is recommended to perform laparoscopic or traditional open surgery (including liver resections).

Multiple doctors, different recommendations for multiloculated pyogenic hepatic abscesses

Multiple doctors, different recommendations for multiloculated pyogenic hepatic abscesses

Unique Presentation of Endogenous Klebsiella Endophthalmitis From a Pyogenic Hepatic Abscess

The following is a rare presentation of endogenous klebsiella endophthalmitis associated with a pyogenic liver abscess. A 64-year-old Cantonese male presented to our tertiary care center with subjective fevers and left eye vision loss. His vision loss began four days prior to presentation and was associated with progressive pain, swelling, and redness of the same eye. Orbital CT with contrast confirmed presence of both periorbital and post-septal orbital cellulitis, as well as endophthalmitis. Infection was presumed to be from an endogenous source given the patient's fevers, so the patient was started on intravenous vancomycin, ceftazidime, and metronidazole. Blood cultures taken in the emergency room prior to the administration of antibiotics revealed no growth over the next five days. A CT abdomen/pelvis obtained to determine an infectious source revealed a 7 cm x 5 cm liver abscess. Interventional radiology biopsy of the abscess displayed infection with pan-susceptible Klebsiella pneumoniae. Antibiotics were de-escalated to intravenous ceftriaxone and ophthalmology recommended evisceration of the left eye. Six sets of blood cultures all remained negative for Klebsiella bacteremia throughout the patient's hospital course. Klebsiella endophthalmitis is a rare but devastating infection associated with pyogenic hepatic abscesses, particularly in Asian populations. Patients with hepatic abscesses causing systemic symptoms generally present with right upper quadrant pain and sepsis secondary to bacteremia before the onset of ocular symptoms. Our patient uniquely presented with initial symptoms of vision loss coinciding with onset of fevers and had negative blood cultures further complicating diagnosis. Treatment of endogenous endophthalmitis involves intravenous and intravitreal antibiotics, however, infection is rapidly progressive and often leads to permanent vision loss requiring enucleation or evisceration of the eye. Given the low incidence of ophthalmic disease in patients with pyogenic hepatic abscesses, there are no current guidelines for routine ophthalmology screening in the absence of visual symptoms. However, physicians should monitor patients with known liver pathology, particularly those of Asian descent, for complaints of ocular symptoms.

An Exceedingly Rare Presentation of an Asymptomatic but Nearly Fully Occlusive Portal Vein Thromboses Provoked by Pyogenic Hepatic and Pancreatic Abscesses

Portal vein thrombosis (PVT) may present acutely or occur chronically in patients with hepatic cirrhosis. In non-cirrhotic patients, the estimated incidence is < 1%, and is considered an uncommon pathological finding. While provoking agents and initial symptoms are variable, the common pathophysiology involves general flow obstruction within the portal vasculature with possible new or worsening liver failure or portal hypertension. We present a case of a non-cirrhotic patient who presented with PVT secondary to pyogenic abscesses of the liver and pancreas, which is an exceedingly rare condition with only 1.3 cases/ 100,000 female patients. Our patient is a 61-year-old female with a history of ethanol abuse, who presented to the ER with dyspnea secondary to community-acquired pneumonia. On admission, the patient denied pain and had a benign abdominal exam. An elevated INR of 4.1 and history of alcohol abuse, prompted workup for liver cirrhosis. An abdominal US showed a near complete thrombosis of the portal and superior mesenteric veins. This finding was confirmed by an abdominal CT with contrast, which revealed numerous ill-defined masses throughout the liver and at the head of the pancreas. An initial liver biopsy showed no evidence of malignancy but revealed acute and chronic inflammation, micro-abscess formation, and coagulation necrosis. A second liver biopsy corroborated an infectious etiology when 220 mL of perihepatic purulent fluid was collected. In addition to antibiotics, patient also received anti-coagulation therapy for the thrombus. After 2 weeks of treatment, a CT of the abdomen showed resolution of the thrombus within the portal vein and anti-coagulation was discontinued.Figure: A CT ABD slice demonstrating the large thrombosis within the portal vein and associates pyogenic hepatic abscesses.Figure: A CT ABD slice showing the compression and nearly fully occlusive status of the portal vein with visualization of the pancreatic head abscesses.Figure: US image showing nearly fully occlusive portal vein with little to no doppler flow.This case demonstrates a rare case of portal vein thrombosis in a non-cirrhotic patient attributed to pyogenic abscesses within the liver and the pancreatic head. While many factors are known to promote or exacerbate thrombus formation within the portal system, the infectious etiology has been rarely observed within the literature and therefore, underscores the variable symptomatology of this condition and the high clinical suspicion necessary for its detection.