Phlebosclerotic colitis: radiological findings of an uncommon entity.

Abstract

Hong Kong Med J ⎥ Volume 21 Number 6 ⎥ December 2015 ⎥ www.hkmj.org A 46-year-old Chinese woman attended our accident and emergency department because of abdominal pain, no bowel movements, and vomiting for 10 days in February 2014. A plain abdominal radiograph revealed a dilated small bowel, ascending and transverse colon (Fig 1). Multiple short linear calcifications scattered along the medial aspect of the ascending colon were observed (Fig 2). Contrastenhanced computed tomography (CT) revealed a long segment of circumferential bowel wall thickening and oedema involving the caecum, the whole length of the ascending colon, hepatic flexure, and the proximal part of the transverse colon. Prominent vascular calcifications that involved the mesenteric vessels over the ascending colon were also visualised (Fig 3). The patient was admitted to a surgical unit and emergency laparotomy was arranged with a provisional diagnosis of intestinal obstruction. Intraoperatively, the colon was found to be ischaemic from the caecum to the splenic flexure. The small bowel was dilated and the superior mesenteric artery was patent and pulsatile. Extended right hemicolectomy and end ileostomy were performed. Histopathology of a surgical specimen showed most of the submucosal veins to have luminal occlusion by intimal thickening and a hyalinised wall with calcification. The pathological diagnosis was phlebosclerotic colitis (PC). Postoperatively, the patient’s recovery was complicated by pneumonia that was successfully treated with antibiotics. She was discharged home 18 days after admission. Elective closure of the end ileostomy was performed a few months later. Ischaemic bowel disease is commonly caused by thrombosis and embolism in the mesenteric artery. Obstructed mesenteric veins causing ischaemia are rarely reported. Phlebosclerotic colitis is characterised by sclerosis and calcification of the mesenteric veins leading to large bowel ischaemia. Interestingly, a genetic factor is thought to play an important role in this disease since most patients with PC are of Asian descent. It has been suggested that portal hypertension may contribute to the condition but there is insufficient evidence to support this relationship.1 The most common symptoms of PC are abdominal pain, vomiting, and recurrent diarrhoea. The clinical course is fairly long because it is caused by chronic venous insufficiency and congestion. Serious complications including ileus and intestinal perforation have been reported.2,3 Phlebosclerotic colitis has distinct radiological findings. Plain radiographs may demonstrate multiple tortuous threadlike vascular calcifications commonly over the PICTORIAL MEDICINE