Mesenteric phlebosclerosis

Mesenteric phlebosclerosis associated with long-term oral intake of geniposide, an ingredient of herbal medicine

BACKGROUND

Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease, characterised by thickening of the wall of the right hemicolon with calcification of mesenteric veins. However, the aetiology remains unknown.

AIM

To investigate the possible association of herbal medicines with IMP.

METHOD

The clinical data of four of our own patients were collected. Furthermore, we searched for previous reports about similar patients with detailed descriptions of herbal prescriptions that they had taken. We compared herbal ingredients to identify the toxic agent as a possible aetiological factor.

RESULTS

Clinical data on a total of 25 patients were summarised. Mean age was 61.8 years and there was female predominance (6 men and 19 women). The used Kampo prescription, the number of cases, and the mean duration of use were as follows: kamisyoyosan in 12 cases for 12.8 years, inshin-iseihaito in 5 cases for 13.4 years, orengedokuto in 4 cases for 14.3 years, inchinkoto in 1 case for 20 years, kamikihitou in 1 case for 19 years, seijobofuto in 1 case for 10 years and gorinsan in 1 case for an unknown duration. Only one ingredient, sansisi, was common to the herbal medicines of all 25 patients. This crude drug called geniposide in English is a major constituent of the Gardenia fruits.

CONCLUSION

The long-term use of geniposide in herbal medicines appears to be associated with mesenteric phlebosclerosis.

[A case of phlebosclerotic colitis in a hemodialysis patient]

Phlebosclerotic colitis is a rare disease of intestinal ischemia caused by calcified peripheral mesenteric veins and a thickened colonic wall, differentiating it from the typical ischemic colitis. A 68-year-old man who was undergoing hemodialysis presented with hematochezia and abdominal pain. Colonoscopic findings showed typical dark purple-colored edematous mucosa. Linear calcifications in the colon were noted on both a plain abdominal radiolography and abdominal computer tomography. These findings suggested that the patient suffered from phlebosclerotic colitis. Following bowel rest and fluid therapy, there was full recovery. We herein report a rare case of phlebosclerotic colitis in a hemodialysis patient and include a review of the relevant literature.

Phlebosclerotic colitis in a cirrhotic patient with portal hypertension: the first case in Korea

Phlebosclerotic colitis is a rare form of ischemic colitis characterized by the thickening of the wall of the affected colon due to fibrous degeneration of submucosal layer of colon and fibrotic obstruction of the colono-mesenteric vein, resulting in the disturbance of venous return from the colon. The pathogenic mechanism of this entity remains unknown but chronic liver disease with portal hypertension is maybe thought to be one of the speculated mechanisms. Here we first report the case of surgically confirmed phlebosclerotic colitis, that was in the early stage but showed the aggressive nature, in a 61-yr-old cirrhotic patients with portal hypertension in Korea.

Imaging of ischemic colitis

Ischemic colitis accounts for more than half of all cases of gastrointestinal ischemia and constitutes between 1 per 2000 and 3 per 1000 acute hospital admission. It typically affects elderly patients, being a frequent cause of rectal bleeding, abdominal pain, and diarrhea. This article describes the epidemiology, physiology, and pathology of this underdiagnosed condition; reviews the clinical patterns of this disease, which constitute a key diagnostic point in patients who have a thickening of the colonic wall; and describes the ultrasound (US) and CT findings, pitfalls, and differential diagnoses of ischemic colitis. The value and limitations of US and CT at the different diagnostic stages is discussed.

New histologic findings in idiopathic mesenteric phlebosclerosis: clues to its pathogenesis and etiology--probably ingested toxic agent-related

BACKGROUND

Idiopathic mesenteric phlebosclerosis (IMP) is a recently known and rare disease entity, which is a member of non-thrombotic, non-inflammatory stenosis or occlusion of the mesenteric veins. In spite of the unique histopathology and particular location, the cause and pathogenesis of IMP remain unknown. The aim of this brief study was to propose a pathogenesis and possible etiology based on the reviewed clinical data and some newly discovered pathologic findings in several recent cases in our and other hospitals.

METHODS

The clinical data of 5 patients were collected, with detailed tracing of past history, drug use and dietary habit. The histologic sections were reviewed in detail, with additional histochemical stains and immunohistochemical stains in 4 available cases.

RESULTS

The most important of our findings other than the previously described typical features was a unique type of coagulative necrosis, which we call mummification, involving not only the muscular coat of veins in early and late phases but also the subsequent hyperplastic myointima in veins, portion of the media of arteries closely neighboring the sclerotic vein, a zone of muscular wall of the colon around the passing sclerotic veins and the inner zone of muscular wall of the colon, and accompanied by fibrosis/sclerosis and then calcification in the damaged tissues. Two of our patients were a couple who had been taking Chinese herbs regularly.

CONCLUSION

A pathogenesis is suggested for at least a subgroup of cases of IMP: the disease is initiated by a slow but longstanding direct hypoxic injury to the venous muscular layer, which leads to gradual mummification and then sclerosis and calcification of the venous muscle. This is followed by the repeated same damage of the subsequent reactively hyperplastic myointima in the veins, and these changes finally result in gradual venous occlusion. Certain toxins or biochemicals, probably existing in the frequently ingested contents and absorbed to the venous return, may play the most important role in this damage. However, analysis of more cases is required to support the proposal, and if such support is found, the toxic agents remain to be clarified via further laboratory investigations.

Phlebosclerotic colitis with deep circumferential ulceration: three-year endoscopic follow-up. Report of a case

We report a case of phlebosclerotic colitis with deep circumferential ulceration in which the characteristic findings were observed radiologically and endoscopically. Previously, the patient was diagnosed with colitis of unknown etiology in 1999 when a colonoscopy showed small erosions, ulcers, and dark purple mucosa in the right colon. As a result of parenteral nutrition treatment, his symptoms and ulcerations disappeared; however, the dark purple mucosa remained unchanged for three years on the annual endoscopic follow-up. Recurrent colitis associated with circumferential ulceration was diagnosed in 2002. The patient was treated again with only parenteral nutrition and his symptoms improved after a few days; the ulceration completely disappeared within seven months. This case emphasizes the benefit of nonsurgical treatment for phlebosclerotic colitis even in cases of deep circumferential ulceration.

Phlebosclerotic colitis: imaging-pathologic correlation

OBJECTIVE

The objective of this study was to analyze the imaging findings of phlebosclerotic colitis in comparison with histologic findings.

CONCLUSION

Calcifications and/or obstructions of the veins of the colonic wall and adjacent mesentery and collateral formation, edematous thickening of the colonic wall, and increased density in the fatty tissue of the surrounding mesentery were features of this rare entity. However, in the early stage of the disease, no definite calcification of the affected veins was observed.

Phlebosclerotic colitis coincident with carcinoma in adenoma

Phlebosclerosis of the colon is a rare disease characterized by a thickening of the wall of the colon with fibrosis, hyalinization and calcification to the affected veins. These symptoms result in a type of ischemic colitis known as phlebosclerotic colitis. A case of phlebosclerotic colitis coincident with carcinoma in adenoma is reported. A 74-year-old Japanese woman was admitted to hospital because of a mass in her right lower abdomen. Abdominal computed tomography examination revealed linear calcifications in the wall of the cecum and the ascending colon. Colonoscopy revealed dark purple mucosa with multiple ulcers in the cecum and the ascending colon. Biopsy specimens showed a marked hyalinous thickening of the wall of small blood vessels in the mucosa. Phlebosclerotic colitis was suspected because of negative results with amyloid stain. Alternative ileocolic angiography showed the serpentine of the peripheral nature blood vessels and pooling at the late venous phase. Microscopic examination of the surgically resected colon revealed mucosal and submucosal fibrosis, and a thickening of the venous wall with fibrosis, hyalinization and calcification from the mucosa to the serosa, which caused a marked luminal narrowing. A small polypoid lesion was also found in the affected region and was diagnosed histologically as carcinoma in adenoma. To our knowledge, this is the first reported case of phlebosclerotic colitis complicated by carcinoma.