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Pylephlebitis is a thrombophlebitis of the portal vein, or its tributaries, secondary to an intra-abdominal infectious process. We present a case of a 40-year-old male, who went to the Emergency Department with lower abdominal pain and biliary vomiting with eight days of evolution. Analytically: leucocytosis 17 000 uL and high C-reactive protein. Abdominal ultrasound exam was compatible with acute appendicitis. The patient underwent a McBurney’s appendectomy and was admitted to the Surgery Department. By the second day of hospitalization he initiated fever and abdominal distension. The abdominal computed tomography scan showed an endoluminal thrombus, not totally obstructive, in the portal vein, that reached into the superior mesenteric vein. The patient initiated hypocoagulation and antibiotic therapy and was oriented to consultation, where we performed prothrombotic study and excluded causes of hepatic disease. Image study after 3 months of hypocoagulation showed recanalization of the portal vein thrombosis, without collateral vein formation.