Diverticulitis-Associated Mesenteric Venous Thrombophlebitis: A Case Report and Systematic Review of Diagnosis, Management, and Outcomes

Diverticulitis can rarely seed the portal‑mesenteric venous system, causing septic thrombophlebitis with morbidity and management uncertainty. This study systematically reviewed diverticulitis‑associated mesenteric venous thrombophlebitis to summarize its presentation, diagnostics, treatment, and outcomes. Twenty‑eight single‑patient reports met the selection criteria. The mean age was 54 years; fever and abdominal pain predominated. Contrast‑enhanced CT established the diagnosis in most patients, usually showing sigmoid diverticulitis with inferior mesenteric or portal‑mesenteric vein thrombus. Sigmoid involvement predominated, and inferior mesenteric vein involvement was common. Blood cultures were positive in 53.6% (common organisms: Bacteroides, Escherichia coli, and Klebsiella). Abscess, venous gas, and perforation were frequent. Broad‑spectrum antibiotics were universal, and anticoagulation was given in 82.1%, and surgery was performed in 53.6% for deterioration or complications. In a complete‑case comparison of 23 anticoagulated versus five non‑anticoagulated patients, times to symptom resolution, radiographic clearance, and length of stay were similar, with venous recanalization documented in 30.4% versus 20.0% and adverse events in 26.1% versus 0%, respectively. Overall, the length of stay averaged 19 days. Radiographic resolution occurred at approximately three months with venous recanalization in 28.6% of cases, and no deaths or recurrences. In conclusion, early CT, prompt antibiotics, consideration of anticoagulation for extensive or occlusive thrombosis, and selective drainage or resection appear prudent, but prospective data will be needed.