Idiopathic mesenteric phlebosclerosis missed by a radiologist at initial diagnosis: A case report

BACKGROUND Idiopathic mesenteric phlebosclerosis(IMP)is a rare type of ischemic colitis characterized by thickening of the wall of the right hemicolon and calcification,sclerosis,and fibrosis of mesenteric veins.The diagnosis of IMP is based on typical clinical features and imaging findings.We report a case of IMP that was initially missed by the radiologist.CASE SUMMARY A 77-year-old woman was admitted to the hospital due to chronic diarrhea for over 2 months.She had been consuming Chinese patent medicines(CPM)containing fructus gardeniae for more than 15 years.Colonoscopy revealed an edematous mucosa,bluish-purple discoloration,erosions,and ulcerations throughout the colorectal area.Abdominal computed tomography(CT)showed diffuse mural thickening of the entire colorectum,with tortuous thread-like calcifications in the right hemicolon,left hemicolon,and rectum.Most of the calcifications were located in the mesenteric vein.The diagnosis of IMP was established based on medical history,colonoscopy,CT findings,and histopathological examination.The patient was treated conservatively with papaverine and rifaximin,and CPM was stopped.Her diarrhea symptoms improved,indicating the effectiveness of the treatment.Over the next several years,she took opium alkaloids for an extended period and did not require hospitalization for the aforementioned gastrointestinal disorder.CONCLUSION IMP is a rare gastrointestinal disease affecting Asian populations,possibly related to long-term herbal medicine intake.Accurate imaging analysis is crucial for diagnosis,but insufficient understanding of the disease can lead to misdiagnosis or missed diagnosis.Treatment strategies should be personalized.

Phlebosclerosis: An overlooked complication of varicose veins that affects clinical outcome: A case report

BACKGROUND Phlebosclerosis is a common age-related fibrotic degeneration of the venous wall.It is a disorder rather than a disease,which may cause venous dysfunction and even venous thrombosis.It is rarely reported in patients with varicose veins.CASE SUMMARY The present report describes the case of a 70-year-old man with varicose veins,vitiligo,and phlebosclerosis.Venous angiography revealed blood reflux in the superficial and deep veins.The patient underwent surgery to remove the saphe-nous veins.During the operation,a calcified vein resembling a wooden stick was found,which was surprisingly extracted from the thickened venous wall.A cross-section of this wooden stick-like vein revealed venous fibrosis and calcification,obvious thickening of the venous wall,extensive collagen deposition on the venous wall,hyaline degeneration,and venous sclerosis causing closure of the venous lumen.CONCLUSION This is probably the first report of a wooden stick-like structure being found in the venous wall in patients with varicose veins and venous ulcers.Phlebosclerosis can be observed in the late stage of varicose veins complicated by frequent infections and worse clinical outcomes.Therefore,it is important to be aware of this condition and address it rather than overlook it.

Idiopathic mesenteric phlebosclerosis associated with long-term use of medical liquor:Two case reports and literature review

A 62-year-old woman was admitted to our hospital in2011 because of recurrent abdominal pain,nausea and constipation for six months.Computed tomography enterography(CTE)showed tortuous thread-like calcifications in the ileocolic vein and right colic vein,while colonoscopy revealed purple-blue mucosa extending from the cecum to the splenic flexure.Based on the results of these tests,the patient was diagnosed with idiopathic mesenteric phlebosclerosis(IMP).She had a history of Chinese medical liquor intake for one and a half years and her symptoms subsided after conservative treatment.In 2013,a 63-year-old male patient who presented with recurrent lower right abdominal pain,bloating,melena and diarrhea for fifteen months was admitted to our institution.Colonoscopy and CTE led to the diagnosis of IMP.He also used Chinese medical liquor for approximately 12 years.The patient underwent total colectomy and the postoperative course was uneventful.We searched for previously published reports on similar cases and analyzed the clinical data of 50 cases identified in PubMed.As some of these patients admitted use of Chinese medicines,we hypothesize that Chinese medicines may play a role in the pathogenesis of IMP.

Idiopathic mesenteric phlebosclerosis associated with long-term oral intake of geniposide

BACKGROUND Idiopathic mesenteric phlebosclerosis(IMP)is a rare disease,and its etiology and risk factors remain uncertain.AIM To investigate the possible influence of Chinese herbal liquid containing geniposide on IMP.METHODS The 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.RESULTS The 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).CONCLUSION Long-term oral intake of Chinese herbal liquid containing geniposide may play a role in the pathogenesis of IMP.

Mesenteric phlebosclerosis with amyloidosis in association with the long-term use of medicinal liquor: A case report

BACKGROUND Mesenteric phlebosclerosis(MP)is a rare disease of the colon.The clinical manifestations of this disease are nonspecific and it may easily be misdiagnosed.We report a case of MP with amyloidosis in the colonic vessel walls in a patient with hypertension who had been consuming Chinese medicinal liquor for 10 years.We also review the relevant literature and summarize the characteristics of MP in patients in China's Mainland.CASE SUMMARY A 64-year-old man was referred to our department from his primary hospital because of abdominal pain,diarrhea,and fever for almost 10 d.Computed tomography showed colon wall thickening,with threadlike calcifications in the mesenteric vein in the transverse colon.Colonoscopy revealed purple-blue mucosa with multiple ulcers in the ascending and transverse colon.Biopsy showed thickening and calcification of the vein walls,perivascular and mucosal collagen degeneration,and amyloidosis.The patient had been consuming Chinese medicinal liquor,mainly that made from gardenia fruit,for 10 years.Based on these results,a diagnosis of MP with amyloidosis was made.After conservative treatment,the patient’s discomfort subsided and he was followed closely.The use of Chinese herbal medicine was suspected to play a role in the pathogenesis of MP.CONCLUSION The clinical manifestations of MP are nonspecific.Recognition of its typical imaging findings,including multiple calcifications on computed tomography and purple-blue mucosal discoloration on colonoscopy,is vital.