Idiopathic Mesenteric Phlebosclerosis Research Articles

Calcification of the mesenteric veins suspected of idiopathic mesenteric phlebosclerosis associated with long‐term herbal medicine ‘inchinkoto’ prescribed for biliary atresia: A multicenter study

AbstractAimInchinkoto (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.

Severe Venous Calcifications in Phlebosclerotic Colitis and Significantly Decreased Expression in Betaine.

Phlebosclerotic colitis (PC) is a rare type of chronic ischemic colitis. Its etiology is still unknown, and PC is also known as idiopathic mesenteric phlebosclerosis colitis. Currently, many studies have reported that long-term use of Chinese herbal medicine and drinking history are related to its pathogenesis. In the early stage of the lesion, due to insufficient understanding of PC, it is difficult to distinguish it from inflammatory bowel disease and other nonneoplastic intestinal diseases. We reported a case of severe diffuse total colon calcification with multiple misdiagnosis, summarizing and analyzing the clinical pathological characteristics to increase clinical and pathological physicians' understanding of the disease and reduce misdiagnosis. Moreover, for the first time, we conducted metabolomics sequencing on fresh intestinal specimens of PC, in order to explore the possible mechanism of severe calcification in the patient. We found that betaine was significantly decreased in the intestinal specimens of the patient, which is an amino acid that has been shown to improve vascular risk factors, and may be one of the mechanisms underlying severe calcification in the patient.

Idiopathic mesenteric phlebosclerosis combined with melanosis coli in a 51-year-old woman.

Idiopathic mesenteric phlebosclerosis (IMP) is a rare ischemic colitis characterized by calcification of mesenteric veins and submucosal veins of the colon. Melanosis coli (MC) is a pigmented mucosal lesion comprising macrophages in the lamina propria of the colorectal mucosa that contain lipofuscin. This study reports a case of IMP combined with MC.Clinicians should consider medication history, bowel preparation, and thorough observation to prevent missed IMP diagnosis when coexisting with MC.

Not all right lower abdominal pain is appendicitis

British Journal of Hospital MedicineEarly view Images in MedicineNot all right lower abdominal pain is appendicitisYoen Young Chuah, Mindy Ming-Huey Guo, Yeong Yeh LeeYoen Young ChuahCorrespondence to: Yoen Young Chuah; E-mail Address: [email protected]Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ping Tung Christian Hospital, Ping Tung City, TaiwanDepartment of Nursing, Meiho University, Pingtung, TaiwanSearch for more papers by this author, Mindy Ming-Huey GuoDepartment of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanSearch for more papers by this author, Yeong Yeh LeeDepartment of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bahru, MalaysiaSearch for more papers by this authorYoen Young Chuah; Mindy Ming-Huey Guo; Yeong Yeh LeePublished Online:15 Mar 2023https://doi.org/10.12968/hmed.2022.0237AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Chang KM. New histologic findings in idiopathic mesenteric phlebosclerosis: clues to its pathogenesis and etiology–probably ingested toxic agent-related. J Chin Med Assoc. 2007;70(6):227–235. https://doi.org/10.1016/S1726-4901(09)70364-8 Crossref, Medline, Google ScholarHiramatsu K, Sakata H, Horita Y et al.. Mesenteric phlebosclerosis associated with long-term oral intake of geniposide, an ingredient of herbal medicine. Aliment Pharmacol Ther. 2012;36(6):575–586. https://doi.org/10.1111/j.1365-2036.2012.05221.x Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails Ahead of PrintISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 15 March 2023 Information© MA Healthcare LimitedPDF download

Idiopathic Mesenteric Phlebosclerosis: A Single-Institute Experience in Taiwan.

Idiopathic mesenteric phlebosclerosis is a rare condition with unclear pathogenesis. This study aimed to investigate the clinical features, diagnostic modalities, treatments, and outcomes of idiopathic mesenteric phlebosclerosis patients in Taiwan. Idiopathic mesenteric phlebosclerosis patients diagnosed by the typical characteristic of tree-like mesenteric venous calcifications on plain abdominal radiography or computed tomography between January 1992 and July 2021 were retrospectively analyzed. Totally, 36 idiopathic mesenteric phlebosclerosis patients were enrolled (50% females; mean age, 61.6 years). Among the included patients, 26 (72.2%) and 10 (27.7%) were symptomatic and asymptomatic, respectively. Abdominal pain (61.1%) accounted for the majority of all symptoms, followed by fever, diarrhea, and bloody stools. Our results showed that 83.3% of patients had at least 1 risk factor, whereas 16.6% of patients had none. Moreover, among the included patients, 36.1%, 44.4%, 50.0%, 38.8%, and 8.3% had cardiovascular disease, chronic renal disease, cancer, chronic liver disease, and diabetes mellitus, respectively. Our findings showed 94.4% of patients were diagnosed via abdominal computed tomography and plain abdominal radiography, whereas 5.6% of patients were diagnosed via plain abdominal radiography. The ascending colon was the most commonly involved site (100%). Our findings showed that 91.6% of patients experienced good recovery after conservative treatment, except for the 3 who died of sepsis and respiratory failure. By contrast, 8.3% of idiopathic mesenteric phlebosclerosis patients underwent colectomy. The average follow-up duration was 62.5 months. Idiopathic mesenteric phlebosclerosis remains a rare disease in Taiwan. Plain abdominal radiography and computed tomography can be utilized for establishing a definite diagnosis. Conservative treatment is usually adequate for most patients, with surgical treatment only indicated for severe cases.

Idiopathic Mesenteric Phlebosclerosis

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.

An unusual colonic mass in a phlebosclerosis patient

A 47-year-old man with idiopathic mesenteric phlebosclerosis presented to our hospital because of a 2-month history of diarrhea and edema of both lower limbs. Contrastenhanced abdominal computed tomography (CT) showed a 2-cm mass of mixed density in the ascending colon. On coloscopy, a solid, ulcerated, semi-pedunculated, lobulated protruding mass of 3.5×3.5×1.5 cm was observed and removed with hot snare polypectomy. Histologic examination demonstrated a hamartomatous polyp with normal epithelium and an inflammatory infiltrate with dilated, mucus-filled cystic glands in the lamina propria, indicating a juvenile polyp.

Idiopathic mesenteric phlebosclerosis (IMP) with sepsis and death: a case study

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 associated with long-term oral intake of geniposide.

BACKGROUNDIdiopathic mesenteric phlebosclerosis (IMP) is a rare disease, and its etiology and risk factors remain uncertain.AIMTo investigate the possible influence of Chinese herbal liquid containing geniposide on IMP.METHODSThe detailed formula of herbal liquid prescriptions of all patients was studied, and the herbal ingredients were compared to identify the toxic agent as a possible etiological factor. Abdominal computed tomography (CT) and colonoscopy images were reviewed to determine the extent and severity of mesenteric phlebosclerosis and the presence of findings regarding colitis. The disease CT score was determined by the distribution of mesenteric vein calcification and colon wall thickening on CT images. The drinking index of medicinal liquor was calculated from the daily quantity and drinking years of Chinese medicinal liquor. Subsequently, Spearman’s correlation analysis was conducted to evaluate the correlation between the drinking index and the CT disease score.RESULTSThe mean age of the 8 enrolled patients was 75.7 years and male predominance was found (all 8 patients were men). The patients had histories of 5-40 years of oral Chinese herbal liquids containing geniposide and exhibited typical imaging characteristics (e.g., threadlike calcifications along the colonic and mesenteric vessels or associated with a thickened colonic wall in CT images). Calcifications were confined to the right-side mesenteric vein in 6 of the 8 patients (75%) and involved the left-side mesenteric vein of 2 cases (25%) and the calcifications extended to the mesorectum in 1 of them. The thickening of colon wall mainly occurred in the right colon and the transverse colon. The median disease CT score was 4.88 (n = 7) and the median drinking index was 5680 (n = 7). After Spearman’s correlation analysis, the median CT score of the disease showed a significant positive correlation with the median drinking index (r = 0.842, P < 0.05).CONCLUSIONLong-term oral intake of Chinese herbal liquid containing geniposide may play a role in the pathogenesis of IMP.

Idiopathic mesenteric phlebosclerosis: clinical and CT imaging characteristics.

The aim of our study was to evaluate the clinical characteristics and computed tomography (CT) imaging findings of idiopathic mesenteric phlebosclerosis (IMP). From January 2013 to May 2019, the clinical data of 10 patients diagnosed with IMP were analyzed retrospectively. Computed tomography angiography (CTA) and colonoscopy were performed in all 10 patients. All CT imaging findings were evaluated by three radiologists, including the form and distribution of calcification, the bowel's thickness, and the surrounding fat gap. The calcification score was calculated according to the extent of the involved mesenteric veins. The colonic wall thickness was defined as the average value of the thickest and thinnest regions of the intestinal wall. The correlation between the calcification scores and the colonic wall thickness was analyzed using Spearman's correlation analysis. All 10 patients were male with an average age of 59.6 years (range, 51-83 years). The average smoking index was 712 (range, 0-1,800). Among them, 7 patients had a history of long-term excessive daily intake of medicinal liquor or Chinese herbal medicine. Clinical symptoms of abdominal pain, diarrhea, bloating, and nausea were found. Colonoscopy showed dark purple discolorations of the edematous mucosa, engorged blood vessels, extensive erosion, ulceration, and multi-focal nodular surface in all patients. CT demonstrated colonic wall thickening, calcification along the mesenteric vein, and blurry surrounding fat gap in all 10 patients. Mesenteric venous calcification involved the terminal ileum, the ascending and transverse colon in all patients, and the descending colon and sigmoid colon's involvement in two patients. A total of 33 segments of the intestinal wall were involved. The median calcification score was 6 points, the mean thickness of the colonic wall was 10.73±3.22 mm, and there was no significant correlation (P=0.782) between calcification score and thickness of the colonic wall. The main features of IMP are mesenteric venous calcification, colonic wall thickness, and pericolic fat stranding, and there is no correlation between calcification score and colonic wall thickness. Therefore, CT imaging combined with colonoscopy can improve the diagnostic accuracy of IMP.

Clinicopathological features of phlebosclerotic colitis

Phlebosclerotic colitis (PC) is a rare chronic ischemic colitis caused by venous reflux disorder. It is also called idiopathic mesenteric phlebosclerosis (IMP) due to unknown etiology. The disease is characterized by sclerosis of mesenteric vein and its branches as well as fibrosis, hyaline degeneration, calcification, thickening of colon wall. CT images show linear calcification in the colon mucosa as well as mesenteric vein and its branches. Endoscopy shows purple-blue mucosa with multiple erosion and ulceration. Microscopically, the colon mucosa shows fibrosis, hyaline degeneration and extensive thickening. The most characteristic lesion is fibrosis and calcification of the vessels especially the veins. Arteries in all layers of colon are also involved, but the injury is significant mild and less. We collected 10 confirmed patients from 2012 to 2019 in our hospital, studied their clinical histories in detail, summarized typical changes of CT images, endoscopic images and pathological sections, and made a detail follow-up. In addition to typical pathological changes, we also found that gardenia or its metabolites may be the pathogenic factor. Probablely, geniposide which is metabolized to genipin by β-glucosidase of colon flora in proximal colon, results in venous sclerosis. PC is occult onset and irreversible without special symptoms in the early stage, but it will also be stable after removing the pathogenic ingredient. Most of patients may be “cured” by appropriate conservative medication and stopping drinking. Contrary, inappropriate surgery may “trigger” the acute ischemia which results in obstruction rapidly. We hope our colleagues pay attention to the unique lesion and make early diagnosis and treatment.

Idiopathic mesenteric phlebosclerosis caused by traditional medicine in a married couple and review of literature

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.

Idiopathic mesenteric phlebosclerosis associated with herbal drugs presenting with asymptomatic fecal occult blood.

A 77-year-old man who had been taking Chinese herbal drugs containing gardenia fruit for a long time visited our hospital following a positive fecal occult blood test. A computed tomography scan showed multiple linear calcifications distributed on the right-side mesenteric veins, which is a typical finding of idiopathic mesenteric phlebosclerosis (IMP).

Idiopathic mesenteric phlebosclerosis: one case report and literature review

Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease and it is easy to be misdiagnosed, which is characterized by intestinal obstruction symptoms, such as abdominal pain, bloating and vomiting. In this study, a case of IMP was observed and the literatures were reviewed. Computed tomography shows funicular high-density shadow and vascular calcification shadow along the vessels around the bowels. Narrow band imaging (M-NBI) endoscopy revealed the disappeared honeycomb capillary, the disordered microvascular structure and the increased density of blood vessels.

A Case of Idiopathic Mesenteric Phlebosclerosis treated by Laparoscopic-Assisted Subtotal Colectomy

A Case of Idiopathic Mesenteric Phlebosclerosis treated by Laparoscopic-Assisted Subtotal Colectomy

The role of CT in predicting the need for surgery in patients diagnosed with mesenteric phlebosclerosis.

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.

&lt;b&gt;漢方専門外来の長期間通院患者における特発性腸間膜静脈硬化症罹患者に関する検討&lt;/b&gt;

特発性腸間膜静脈硬化症（idiopathic mesenteric phlebosclerosis, IMP）は，腸間膜静脈壁硬化に起因した還流障害による慢性虚血性腸病変で，右半結腸を主体に，青銅色調の粘膜変化，腹部単純X 線撮影検査や腹部CT 検査での腸管や腸管周囲静脈の石灰化を特徴とする。近年漢方薬長期投与中のIMP 発症例を散見するが，漢方診療を専門に行う外来での実態は明らかではない。今回，諏訪中央病院東洋医学センターを5年以上通院する患者を対象としてIMP 罹患の有無を検索したところ，対象257名中2名（0.8%）で認めた。いずれも山梔子を含む方剤を長期服薬し，一例は急性腹症で緊急手術が施行され，一例は無症状であった。発症機序は不明な疾患であるが，長期に漢方治療を受ける患者，特に山梔子服薬患者においては，その存在を念頭におき，無症状例であっても積極的な画像検索を行う必要があろう。

Conservative treatment of idiopathic mesenteric phlebosclerosis

Summary Ischemic bowel disease is caused by occlusion or stenosis either of the mesenteric artery or, less frequently, of the vein. Phlebosclerotic colitis is a rare chronic and gradually worsening ischemic colitis caused by mesenteric phlebosclerosis, and its symptoms are the gradual onset of right-side abdominal pain with or without diarrhea, and recurrent ileus. The most commonly affected site is the region from the terminal ileum to the sigmoid colon, particularly the cecum and ascending colon. The characteristic radiologic findings of mesenteric phlebosclerosis are luminal narrowing, wall thickening of the affected colon (typically the proximal colon), and calcification of the mesenteric veins. The diagnosis may be made on the basis of imaging findings. We report on a 59-year-old man with periumbilical abdominal pain for 1 week. The pain was dull and persistent. A physical examination revealed a soft, tender abdomen with normoactive bowel sounds and mild rebounding tenderness in the right upper abdomen. The abdominal plain X-ray and abdominal computed-tomography findings were compatible with idiopathic mesenteric phlebosclerosis. The symptoms resolved after only conservative treatment, and the disease did not recur during 5 years of follow-up. Idiopathic mesenteric phlebosclerosis is a rare disease, and its pathogenesis is not yet clearly understood; however, it differs from other rare causes of nonthrombotic mesenteric venous occlusion. Idiopathic mesenteric phlebosclerosis can be diagnosed on the basis of imaging findings, and most symptoms resolve only after conservative treatment.

長期間の漢方薬使用が原因と考えられた腸間膜静脈硬化症の1例

長期間の漢方薬使用が原因と考えられた腸間膜静脈硬化症の1例

便潜血陽性を契機に診断された特発性腸間膜静脈硬化症の1例

便潜血陽性を契機に診断された特発性腸間膜静脈硬化症の1例