Idiopathic Mesenteric Phlebosclerosis

Abstract

A 77-year-old woman presented to the outpatient clinic because of anorexia and abdominal pain that had appeared approximately 2 months previously. Her abdomen was soft, but there was no tenderness. Contrast-enhanced computed tomography of her abdomen showed thickening of the wall of her ascending colon and calcification of the mesenteric veins alongside (Figure A). Colonoscopy showed the right half of her colon to be bluish in color, highly edematous, easily induced to hemorrhage, and contained scattered small ulcers (Figure B). A diagnosis of idiopathic mesenteric phlebosclerosis was made after learning that her family doctor had been prescribing Chinese herbal medicine containing sansisi for her for several years. In the present case, the Chinese herbal medicine was discontinued, and the symptoms had disappeared 2 months later. Although idiopathic mesenteric phlebosclerosis is a rare disease, it can be diagnosed based on characteristic clinical information and imaging findings. Previous studies have reported that it may be caused by sansisi (called geniposide in English), which is used in Chinese herbal medicine. In Asian countries, herbal medicines are generally made from natural ingredients and are sometimes considered safe, but in reality, the metabolism and pharmacokinetics of many components are not fully understood.