ABSTRACT
Objective:To analyze and summarize the clinical manifestations, imaging and colonoscopy characteristics, treatment and prognosis of idiopathic mesenteric phlebosclerosis(IMP), so as to raise clinicians' awareness of this rare disease.Methods:One case of IMP admitted into the Department of Gastroenterology, Beijing Hospital, was reported.The patient was admitted primarily due to abdominal pain, distension, and obstructed defecation and flatulence for 3 months, and recurrent vomiting for 2 days.Combining the patient's medical history, symptoms, physical signs, imaging and colonoscopy results, IMP was suspected to be the most likely cause for incomplete intestinal obstruction in this case.The literatures on IMP published before April 2021, including case reports, reviews and articles, were collected and analyzed.Based upon information mentioned above, the epidemiological characteristics, pathogenesis, clinical manifestations, diagnosis, treatment and prognosis of IMP were systematically reviewed.Results:A total of 206 cases of idiopathic mesenteric vein sclerosing enteritis had been reported up to April 2021 in the literature, with a male to female ratio of about 2.75∶1.Age was clearly mentioned in 111 case reports, with a median age of 59 years and 36 patients(32.4%)≥65 years old.Common clinical manifestations include abdominal pain, distension, diarrhea, hematochezia, nausea and vomiting, obstructed defecation and flatulence, among others.The lesion is usually at the right side of the colon, including the cecum, ascending colon and transverse colon, with the ascending colon as the most commonly involved site.Imaging characteristics include linear, serrated or tortuous calcification of vessels inside the involved colon segments and adjacent mesenterium, edema and thickening of the intestinal wall, and reactive hyperplasia of lymph nodes, etc.Endoscopic features include edema and thickening of the intestinal wall, discoloration of the mucosa, and tortuous and dilated submucosal vessels.Complications include intestinal obstruction, perforation and necrosis.In most cases, symptoms subside after patients stop taking herbal medicines and go through conservative treatment for microcirculation improvement, anti-inflammation, anti-coagulation, anti-infection, etc.Overall, the prognosis of IMP is satisfactory.Conclusions:IMP is a type of non-obstructive, non-thrombotic and non-inflammatory mesenteric phlebosclerosis that causes intestinal ischemia.The pathogenesis of the disease is still unclear.Combination of characteristic clinical manifestations, imaging especially CT findings, endoscopic and histopathological examinations will help the diagnosis of IMP.
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Objective:To investigate the clinical, imaging and endoscopic characteristics of idiopathic mesenteric phlebosclerosis (IMP).Methods:From January 2010 to December 2020, 14 patients with IMP diagnosed and treated at the Quzhou Hospital Affiliated to Wenzhou Medical University (Quzhou People′s Hospital) were enrolled. All patients underwent abdominal X-ray, contrast enhanced computed tomography (CT) and endoscopy. Three cases accepted double-contrast barium enema and 11 cases underwent endoscopic biopsy. Three of the 14 IMP patients underwent surgery and pathological examination because of intestinal perforation or intestinal obstruction that failed conservative treatment. The general data (such as gender, drinking history, etc.), clinical symptoms, complications, imaging (abdominal X-ray, CT, double-contrast barium enema) and endoscopic features were retrospectively analyzed. Descriptive method was used for statistical analysis.Results:Among the 14 IMP patients, 13 cases were male and one case was female. All the 13 male cases had long history of drinking Chinese herbal medicine wine, among them, 8 patients consumed acanthopanax bark wine. Complications occurred in 7 cases, including 5 cases of intestinal obstruction and 2 cases of intestinal perforation. The clinical symptoms of 14 IMP patients were nonspecific, mostly manifested as abdominal pain (11 cases), abdominal distension (6 cases), diarrhea (6 cases), nausea and vomiting (4 cases), and constipation (2 cases). Abdominal X-ray images mainly showed multiple irregular calcifications along involved colon. The images of 3 patients received double-contrast barium enema demonstrated shallowness or disappearance of semilunar folds, rigid colonic wall, narrowed lumen and " thumb printing". The typical CT images indicated edema and thickening of the involved intestinal wall, blurred mesenteric fat space, spot, thread-like, and curved calcification of mesenteric vein and colonic wall. Typical endoscopic findings included dark-purple colored mucosa, congestion, edema, erosion and ulceration, and focal nodular surface and visible varicose veins.Conclusions:IMP has typical imaging and endoscopic characteristics, and the combination of them can diagnose and evaluate IMP more accurately.
ABSTRACT
<p>Idiopathic mesenteric phlebosclerosis (IMP) is a rare chronic ischemic intestinal disease, mainly in the right hemicolon, characterized by dark purple mucosa on colonoscopy and calcifications of the intestinal wall and mesenteric veins on abdominal radiography and computed tomography. In recent years, many patients who developed IMP over the long-term administration of Kampo medicines have been reported. However, the present status of IMP in patients under long-term treatment with Kampo medicines in departments specializing in Kampo therapy is unclear. We surveyed whether there were any IMP outpatients followed for 5 years or more at the Department of Oriental Traditional Medical Center, Suwa Central Hospital. We detected 2 of 257 (0.8%) patients having IMP. Both patients had undergone long-term treatment with Gardenia fruit. One of them underwent surgery due to acute abdomen, but the other was asymptomatic. The etiology and pathogenesis of IMP are still unclear. However, in patients undergoing long-term treatment with Kampo medicines, particularly containing Gardenia fruit, the possible presence of IMP should be taken into consideration, and active screening using imaging examinations is necessary even in asymptomatic patients.</p>