Idiopathic Mesenteric Phlebosclerosis Presenting as Recurrent Diarrhea.

Recurrent Abdominal Pain in a 55-Year-Old Woman

Idiopathic mesenteric phlebosclerosis (IMP) is a rare gastrointestinal disease with unclear etiology and pathogenesis. IMP occurring in a patient with liver cirrhosis is more scarcely reported than independent IMP. In this study, we reported a case of IMP occurring in a patient with liver cirrhosis, so as to provide a reference for understanding liver cirrhosis with IMP. A 63-year-old man with liver cirrhosis was admitted in the hospital's department of infectious disease because of fatigue and constipation for 1 month. The patient had an irregular medical history of antivirus drug and Chinese herbal medicine intake because of the hepatitis B virus infection. No other abnormalities were found in the functions of the liver, coagulation, renal, or complete blood count. Fecal occult blood tests were all positive in 5 detections. Contrast-enhanced computed tomography revealed liver cirrhosis and showed thickening of the wall of the right hemicolon and multiple calcifications of the mesenteric veins. Mesenteric vein computed tomography venography displayed diffuse colon mural thickening of the right colon and tortuous linear calcification line in the right colic veins. Colonoscopy revealed a purple-blue, swollen, rough, and vanished vascular texture mucosa. He was finically diagnosed as liver cirrhosis with IMP by a series of examinations during hospitalization. His symptoms of fatigue and constipation subsided after conservative treatment and withdraw from Chinese herbal medicine. The patient experienced no obvious discomfort during the follow-up period. A comprehensive medical diagnosis is necessary for the discovery of IMP, especially IMP with liver cirrhosis. Liver cirrhosis maybe play a key role in the development of IMP. The regulatory mechanism of liver cirrhosis contributing to IMP needs to be further studied based on more clinical cases.

Idiopathic mesenteric phlebosclerosis (IMP) is an extremely rare disease with an unclear pathogenesis and risk factors. The clinical manifestations of IMP are mostly non-specific, mainly consisting of digestive symptoms such as abdominal pain, bloating and diarrhea. The diagnosis of IMP mainly relies on abdominal computed tomography (CT) and colonoscopy. Pathological changes associated with IMP often involve fibrous degeneration of the venous wall, which results in the thickening of the colonic wall and longitudinal calcification of the mesenteric arteries. Currently, there is no standard treatment protocol for IMP, and nonsurgical treatment is the mainstay of most medical centers. In this study, we reported a case of a 55-year-old female patient with IMP whose main clinical presentation was recurrent abdominal pain. The patient's initial diagnosis was considered an incomplete intestinal obstruction and received non-surgical treatments; however, the efficacy of the treatment was unsatisfactory. After completing abdominal CT and colonoscopy, we excluded common diseases of the digestive system (e.g., tumors, Crohn's disease), and finally considered that this patient had a high likelihood of IMP. This patient eventually underwent laparoscopic enlarged right hemicolectomy due to recurrent symptoms and poor outcomes of non-surgical treatment. Postoperative pathological results confirmed the diagnosis of IMP. During the follow-up period, the patient recovered well without recurrence of IMP. Furthermore, we have reviewed the literature related to IMP and summarized the etiology, risk factors, diagnostic methods, treatment options and prognosis of IMP.

Unusual Cause of Abdominal Pain

AimInchinkoto (ICKT) is administered to patients with biliary atresia (BA) after surgery. Gardeniae fructus which is contained in ICKT is reported to be associated with idiopathic mesenteric phlebosclerosis (IMP). We investigated the influence of ICKT on calcification of the mesenteric veins suspected of IMP in BA patients.MethodsAll BA patients with native liver survival who received ICKT after Kasai portoenterostomy were reviewed. All patients underwent abdominal computed tomography (CT) during treatment. Calcification of the mesenteric veins on the most recent CT scan after the initiation of ICKT was assessed.ResultsTwenty patients (6 males and 14 females) were enrolled in this study. Of these patients, 17 (85.0%) and 10 (50%) patients had used ICKT for ≥5 years and >10 years, respectively. Calcification of the mesenteric veins was detected in one patient, who was a 14 year old girl. The total dosage of Gardeniae fructus was 21 800 g.ConclusionsThe incidence of calcification of the mesenteric veins in BA patients receiving ICKT was low. However, it is necessary to be aware that ICKT containing Gardeniae fructus is associated with the risk of developing calcification of the mesenteric veins suspected of IMP.

Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease with unclear etiology and pathogenesis. Although most IMP patients have a long-term history of traditional Chinese herbal medicine use, this article reports a case without such a special medical history, which may provide new insights into the disease's etiology. A 59-year-old middle-aged man was admitted to the gastroenterology department due to recurrent upper abdominal pain for 1 month. The fecal occult blood test was weakly positive. No significant abnormalities were found in tumor markers, Epstein-Barr virus, cytomegalovirus, T-SPOT, tuberculosis antibodies, or coagulation function. Computed tomography revealed edema and thickening of the intestinal wall in the ascending colon and part of the transverse colon, accompanied by narrowing of the lumen. Multiple calcifications were observed in the right mesenteric vessels, associated with the affected areas. Colonoscopy findings: a circumferential ulcer was noted in the ascending colon at a distance of 75 to 60 cm from the anus, with partial cyanosis of the mucosa and nodular changes. During hospitalization, a series of tests was conducted, and the final diagnosis was IMP. The patient received conservative treatment during hospitalization. After conservative treatment, the patient's abdominal pain and hematochezia improved, and the findings of computed tomography and colonoscopy also showed improvement in the condition. To date, the patient has not experienced any significant discomfort during follow-up. Diagnosing IMP requires familiarity with its characteristic features and the ability to interpret relevant imaging findings. It is important to note that long-term use of traditional Chinese herbal medicine is not always the cause. Further research, including the analysis of more clinical cases and the performance of animal experiments, is needed to fully understand the etiology and pathogenesis of IMP.

Conservative treatment of idiopathic mesenteric phlebosclerosis

A 53-year-old woman presented with intermittent abrupt abdominal pain and occasional lower gastrointestinal bleeding for two years. She had taken a commercial Chinese tradition medicine (Da Chai Hu Tang) intermittently for health promotion for duration of five years. Idiopathic mesenteric phlebosclerosis was diagnosed by characteristic image findings including right side thread-like calcifications on plain abdominal film, thickened ascending colon wall and venous calcification on computed tomography (CT) scans, and hyperechoic spots of thickened ascending colon wall on abdominal ultrasonography, which is reported for the first time in literature. The colonoscopy showed dark blue pigmentation on the mucosa around ulceration and loss of semilunar colon folds that is compatible to idiopathic mesenteric phlebosclerosis. Surgical intervention with right hemicolectomy was done for recurrent compromised symptoms. Her husband who took the same traditional medicine also was found to have the same disease in the following year. The toxic theory of idiopathic mesenteric phlebosclerosis was supported by two genetically irrelevant patients exposed to the same drug. Idiopathic mesenteric phlebosclerosis should be considered when image studies including ultrasonography show hyperechoic spots in thickened colon wall.

A 62-year-old woman was admitted to our hospital in 2011 because of recurrent abdominal pain, nausea and constipation for six months. Computed tomography enterography (CTE) showed tortuous thread-like calcifications in the ileocolic vein and right colic vein, while colonoscopy revealed purple-blue mucosa extending from the cecum to the splenic flexure. Based on the results of these tests, the patient was diagnosed with idiopathic mesenteric phlebosclerosis (IMP). She had a history of Chinese medical liquor intake for one and a half years and her symptoms subsided after conservative treatment. In 2013, a 63-year-old male patient who presented with recurrent lower right abdominal pain, bloating, melena and diarrhea for fifteen months was admitted to our institution. Colonoscopy and CTE led to the diagnosis of IMP. He also used Chinese medical liquor for approximately 12 years. The patient underwent total colectomy and the postoperative course was uneventful. We searched for previously published reports on similar cases and analyzed the clinical data of 50 cases identified in PubMed. As some of these patients admitted use of Chinese medicines, we hypothesize that Chinese medicines may play a role in the pathogenesis of IMP.

A 74-year-old male was diagnosed with transverse colon carcinoma with idiopathic mesenteric phlebosclerosis (IMP). Extended right hemicolectomy with regional lymph node dissection was performed. It has been reported that IMP develops after taking Chinese herbs containing SANSIS for a long time. In this case, the patient had taken such an herb for more than 3 years. In Japan, total 6 cases have been reported on a tumor with IMP, including this case. Immunohistological examination showed that the IMP findings were particularly strong around the tumor. Thus, this case suggests that there is a link between the tumor and IMP.

Idiopathic mesenteric phlebosclerosis (IMP) is a rare cause of chronic intestinal ischemia. Its clinical manifestations include chronic abdominal pain and/or chronic diarrhea, which are nonspecific and often lead to a delayed diagnosis. IMP is diagnosed based on characteristic radiographic findings of threadlike calcifications in the mesenteric veins coupled with unique pathologic findings. The cause of the disease and pathogenesis remain unknown. Herein, we present a 46-year-old woman who was hospitalized with complaints of chronic abdominal pain and diarrhea for 10 years and a loss of 20 kg in body weight. Colonoscopy revealed diffuse ulcerations and treatment for inflammatory bowel disease was administered. Two weeks after discharge, she returned to our emergency department because of acute abdominal pain. Plain abdominal radiography and computed tomography revealed calcifications and stenosis of the mesenteric veins and accumulation of free air, indicating possible colonic perforation. Emergency surgical intervention and a subtotal colectomy and ileostomy were performed. Pathologic findings confirmed the diagnosis of mesenteric phlebosclerotic colitis. Her postoperative course was complicated by sepsis and she died on postoperative day 3. We hope that this report serves to alert physicians of this potentially lifethreatening disease.

Idiopathic mesenteric phlebosclerosis (IMP) is a rare clinical manifestation of ischemic enteropathy. There are no specific manifestations in the early stages. Digestive symptoms only present in the advanced stage. Diagnosis relies on extensive calcification of the mesenteric venule and extensive intestinal wall thickening via computed tomography (CT) scanning. A 50 years old Chinese woman who had taken herbal medicine for three years was diagnosed with IMP. All treatment after admission was in vain and she died 30 days thereafter. Therefore, when a patient with long-term oral intake of herbal medicine, which contains geniposde, presents with unknown ischemia, abdominal pain, mucinous stools, bloody stools, attention should be paid to screen IMP.

Idiopathic mesenteric phlebosclerosis (IMP) is a rare type of ischemic colitis characterized by thickening of the wall of the right hemicolon and calcification, sclerosis, and fibrosis of mesenteric veins. The diagnosis of IMP is based on typical clinical features and imaging findings. We report a case of IMP that was initially missed by the radiologist. A 77-year-old woman was admitted to the hospital due to chronic diarrhea for over 2 months. She had been consuming Chinese patent medicines (CPM) containing fructus gardeniae for more than 15 years. Colonoscopy revealed an edematous mucosa, bluish-purple discoloration, erosions, and ulcerations throughout the colorectal area. Abdominal computed tomography (CT) showed diffuse mural thickening of the entire colorectum, with tortuous thread-like calcifications in the right hemicolon, left hemicolon, and rectum. Most of the calcifications were located in the mesenteric vein. The diagnosis of IMP was established based on medical history, colonoscopy, CT findings, and histopathological examination. The patient was treated conservatively with papaverine and rifaximin, and CPM was stopped. Her diarrhea symptoms improved, indicating the effectiveness of the treatment. Over the next several years, she took opium alkaloids for an extended period and did not require hospitalization for the aforementioned gastrointestinal disorder. IMP is a rare gastrointestinal disease affecting Asian populations, possibly related to long-term herbal medicine intake. Accurate imaging analysis is crucial for diagnosis, but insufficient understanding of the disease can lead to misdiagnosis or missed diagnosis. Treatment strategies should be personalized.

To determine if imaging findings on computed tomography (CT) can predict the need of surgery in patients with idiopathic mesenteric phlebosclerosis (IMP).This retrospective study included 28 patients with IMP. Abdominal CT images were reviewed to determine the extent and severity of mesenteric calcifications and the presence of findings related to colitides. We compared the number of colonic segments with mesenteric venous calcification, a total calcification score, and the rate of colonic wall thickening, pericolic fat stranding, and bowel loop dilatation between patients undergoing surgery (surgery group) and patients without surgery (nonsurgery group). Comparisons were made using the Mann–Whitney U test and Fisher exact test. Receiver operating characteristic analysis was also performed. Inter-reader agreement for the calcification scores was analyzed using kappa statistics.The number of colonic segments with mesenteric venous calcification and the total calcification scores were both significantly higher in the surgery group than the nonsurgery group (4.33 vs 2.96, P = 0.003; and 15.00 vs 8.96, P <0.001). The areas under the receiver operating characteristics to identify patients who need surgery were 0.96 and 0.92, respectively. The prevalence of bowel loop dilatation in the surgery group was also significantly higher than that in the nonsurgery group (16% vs 100%, P = 0.011).Evaluation of the severity and extent of IMP based on the total mesenteric venous calcification score, number of involved colonic segments, and the presence bowel loop dilatation on CT may be useful to indicate the outcomes of conservative treatment and need for surgery.

Idiopathic mesenteric phlebosclerosis is a rare entity characterized by chronic intestinal ischemia due to calcification and obstruction of the mesenteric veins. Here, we report a patient with idiopathic mesenteric phlebosclerosis treated with laparoscopic subtotal colectomy after evaluation by imaging studies. The patient was a 68-year-old Japanese woman with recurrent abdominal pain who had taken a Chinese herbal medicine for more than 20 years. Abdominal CT showed wall thickening of the right colon with calcification of branches of the superior mesenteric vein. Colonoscopy showed cyanotic mucosa from the cecum to the sigmoid colon. The affected area seen on colonoscopy extended to the distal colon. Despite discontinuation of the herbal medicine, her symptoms did not improve. Laparoscopic subtotal colectomy was performed. This report highlights the importance of appropriately evaluating the extent of the affected preoperatively area based on findings from colonoscopy, CT, and contrast enema.