Idiopathic Mesenteric Phlebosclerotic Colitis: A Case Report

Abstract

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.