Abstract
BackgroundPhlebosclerotic colitis (PC) is a rare form of nonthrombotic colonic ischemia. This retrospective study analyzed the clinical findings and temporal CT changes in 29 PC patients with long-term follow-up.MethodsTwenty-nine patients with characteristic CT features of PC collected between 1997 and 2020 were stratified into the acute abdomen group (AA-group) (n = 10), chronic-progressive group (CP-group) (n = 14) and chronic-stable group (CS-group) (n = 5). Clinical and CT changes during follow-up, comorbidities and final outcomes were compared.ResultsThe AA-group exhibited a significantly thicker colonic wall and more involved segments and pericolic inflammation than the CP-group and CS-group on initial CT (p = < 0.001–0.031). Seven patients in the AA-group who underwent right hemicolectomy had no recurrence during follow-up (mean ± SD, 7.1 ± 3.3 years), and the remaining three patients with renal or hepatic comorbidities who underwent conservative treatment died within 14 days. The CP-group showed significantly higher frequencies of chronic renal failure, urinary tract malignancies and liver cirrhosis than the AA-group (p = 0.005–0.008). In addition, CT follow-up (7.9 ± 4.3 years) showed significant increases in mesenteric venous calcifications, colonic wall thickening and involved colonic segments (p = 0.001–0.008) but conservative treatments were effective. The CS-group remained unchanged for years (8.2 ± 3.9 years).ConclusionsEarly surgery offered excellent prognosis in PC-related acute abdomen denoted by marked right colonic wall thickening and pericolic inflammation on CT. Conservative treatments with a wait-and-watch strategy were appropriate for CP-PC and CS-PC, albeit CP-PC harbored significant increases in calcifications, colonic wall thickening and affected segments in long-term CT follow-up.
Highlights
Phlebosclerotic colitis (PC) is a rare form of nonthrombotic colonic ischemia
Patients who were radiologically suspected of having PC were enrolled based on the following inclusion criteria: (1) the patient had unenhanced or enhanced abdominal Computed tomography (CT) with demonstration of characteristic right colonic curvilinear venous calcifications (> 100 Hounsfield units) along the tributaries of the mesenteric vein [2,3,4,5,6,7,8,9,10,11,12]; (2) for patients managed with conservative treatments, at least one CT follow-up ≥ 2 years after initial diagnosis was available
Our result showed that the Acute abdomen (AA)-group exhibited a significantly thicker colonic wall, more involved segments and pericolic inflammation than the Chronic progression (CP)-group and Chronic stable (CS)-group on initial CT
Summary
Phlebosclerotic colitis (PC) is a rare form of nonthrombotic colonic ischemia. This retrospective study analyzed the clinical findings and temporal CT changes in 29 PC patients with long-term follow-up. Phlebosclerotic colitis (PC) is an unusual form of colonic ischemia histopathologically characterized by noninflammatory extensive fibrotic sclerosis of the thickened venous wall, prominent calcifications within stenotic venous lumen and fibrosis of the lamina propria and/or submucosa of the right colon [1,2,3,4,5,6,7,8,9,10,11,12,13]. Long-term changes of clinical and CT features of PC have not been reported This retrospective study aimed at analyzing the clinical findings and temporal CT changes in 29 PC patients with long-term follow-up to elucidate the variable natural history of this extraordinary condition
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