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Liu H, Feng X, Zhang R, Yuan S, Tian Y, Luo P, Chen J, Zhou X. Safety of medicinal and edible herbs from fruit sources for human consumption: A systematic review. JOURNAL OF ETHNOPHARMACOLOGY 2024; 333:118429. [PMID: 38851470 DOI: 10.1016/j.jep.2024.118429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Medicinal and edible herbs from fruit sources have been increasingly used in traditional Chinese medicine dietotherapy. There are no restrictions on who could consume the medicinal and edible fruits or on the dosage of consumption. However, their safety for human consumption has yet to be established. AIM OF THE STUDY This systematic review aimed to assess the safety of human consumption of 30 medicinal and edible fruits. MATERIALS AND METHODS Seven English and Chinese databases were searched up to May 31, 2023, to collect AE reports following human consumption of medicinal and edible fruits. Eligible reports should include details on the occurrence, symptoms, treatments, and outcomes of AEs. AEs that were life-threatening or caused death, permanent or severe disability/functional loss, or congenital abnormality/birth defects were classified as serious AEs (SAEs). The causality between the consumption of fruits and AEs was graded as one of four ranks: "certain", "probable", "possible", or "unlikely". RESULTS Thirty AE reports related to the consumption of medicinal and edible fruits were included, involving 12 species of fruits: Crataegi fructus, Gardeniae fructus, Mori fructus, Hippophae fructus, Cannabis fructus, Siraitiae fructus, Perillae fructus, Rubi fructus, Longan arillus, Anisi stellati fructus, Zanthoxyli pericarpium, and Lycii fructus. No AE reports were found for the remaining 18 species. A total of 97 AEs, featuring predominantly gastrointestinal symptoms, followed by allergic reactions and neuropsychiatric symptoms, were recorded. Thirty SAEs were noted, with Zanthoxyli pericarpium accounting for the most (14 cases), followed by Perillae fructus (7 cases), Anisi stellati fructus (6 cases), and Gardeniae fructus, Rubi fructus, and Mori fructus (1 case each). Mori fructus was associated with one death. All AEs were concordant with a causality to fruit consumption, judged to be "certain" for 37 cases, "probable" for 53 cases, and "possible" for 7 cases. CONCLUSIONS Our findings suggest that among medicinal and edible fruits, 12 species have AE reports with a causality ranging from "possible" to "definite". SAEs were not scarce. Most AEs may be associated with an excessive dose, prolonged consumption, or usage among infants or young children. No AE reports were found for the remaining 18 species.
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Affiliation(s)
- Huilin Liu
- Graduate School, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Xianjie Feng
- Evidence-based Medicine Research Center, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Rui Zhang
- Evidence-based Medicine Research Center, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Shuai Yuan
- Graduate School, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Yaqi Tian
- Evidence-based Medicine Research Center, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Ping Luo
- Evidence-based Medicine Research Center, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Jianrong Chen
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
| | - Xu Zhou
- Evidence-based Medicine Research Center, Jiangxi University of Chinese Medicine, Nanchang, China; Key Laboratory of Drug-Targeting and Drug Delivery System of Sichuan Province, Chengdu, China.
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Qiu J, Lin C, Ren G, Xu F, Hu T, Le Y, Fan X, Yu Z, Liu Q, Wang X, Dou X. Geniposide dosage and administration time: Balancing therapeutic benefits and adverse reactions in liver disease treatment. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 132:155799. [PMID: 38968789 DOI: 10.1016/j.phymed.2024.155799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/05/2024] [Accepted: 06/02/2024] [Indexed: 07/07/2024]
Abstract
Gardenia jasminoides Ellis, a staple in herbal medicine, has long been esteemed for its purported hepatoprotective properties. Its primary bioactive constituent, geniposide, has attracted considerable scientific interest owing to its multifaceted therapeutic benefits across various health conditions. However, recent investigations have unveiled potential adverse effects associated with its metabolite, genipin, particularly at higher doses and prolonged durations of administration, leading to hepatic injury. Determining the optimal dosage and duration of geniposide administration while elucidating its pharmacological and toxicological mechanisms is imperative for safe and effective clinical application. This study aimed to evaluate the safe dosage and administration duration of geniposide in mice and investigate its toxicological mechanisms within a comprehensive dosage-duration-efficacy/toxicity model. Four distinct mouse models were employed, including wild-type mice, cholestasis-induced mice, globally farnesoid X-activated receptor (FXR) knock out mice, and high-fat diet-induced (HFD) NAFLD mice. Various administration protocols, spanning one or four weeks and comprising two or three oral doses, were tailored to each model's requirements. Geniposide has positive effects on bile acid and lipid metabolism at doses below 220 mg/kg/day without causing liver injury in normal mice. However, in mice with NAFLD, this dosage is less effective in improving liver function, lipid profiles, and bile acid metabolism compared to lower doses. In cholestasis-induced mice, prolonged use of geniposide at 220 mg/kg/day worsened liver damage. Additionally, in NAFLD mice, this dosage of geniposide for four weeks led to intestinal pyroptosis and liver inflammation. These results highlight the lipid-lowering and bile acid regulatory effects of geniposide, but also warn of potential negative impacts on intestinal epithelial cells, particularly with higher doses and longer treatment durations. Therefore, achieving optimal therapeutic results requires a decrease in treatment duration as the dosage increases, in order to maintain a balanced approach to the use of geniposide in clinical settings.
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Affiliation(s)
- Jiannan Qiu
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China; E-institute of Shanghai Municipal Education Committee, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Chen Lin
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China
| | - Guilin Ren
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China
| | - Fangying Xu
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China
| | - Tianxiao Hu
- Department of Ultrasonography, Chinese PLA 903rd Hospital, Hangzhou 310013, China
| | - Yifei Le
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China
| | - Xiaohui Fan
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Zhiling Yu
- Consun Chinese Medicines Research Centre for Renal Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Qingsheng Liu
- Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310000, China
| | - Xiaoning Wang
- E-institute of Shanghai Municipal Education Committee, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Xiaobing Dou
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China.
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Liu S, Tong Y, Shi R, Zeng X, Luo H, Yang P, Cai X, Wang D, Luo H, Wang J. Case report and literature review: Laparoscopic extended right hemicolectomy for a 55-year-old patient with idiopathic mesenteric phlebosclerosis. Front Med (Lausanne) 2024; 11:1382475. [PMID: 39081687 PMCID: PMC11286469 DOI: 10.3389/fmed.2024.1382475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
Idiopathic mesenteric phlebosclerosis (IMP) is an extremely rare disease with an unclear pathogenesis and risk factors. The clinical manifestations of IMP are mostly non-specific, mainly consisting of digestive symptoms such as abdominal pain, bloating and diarrhea. The diagnosis of IMP mainly relies on abdominal computed tomography (CT) and colonoscopy. Pathological changes associated with IMP often involve fibrous degeneration of the venous wall, which results in the thickening of the colonic wall and longitudinal calcification of the mesenteric arteries. Currently, there is no standard treatment protocol for IMP, and nonsurgical treatment is the mainstay of most medical centers. In this study, we reported a case of a 55-year-old female patient with IMP whose main clinical presentation was recurrent abdominal pain. The patient's initial diagnosis was considered an incomplete intestinal obstruction and received non-surgical treatments; however, the efficacy of the treatment was unsatisfactory. After completing abdominal CT and colonoscopy, we excluded common diseases of the digestive system (e.g., tumors, Crohn's disease), and finally considered that this patient had a high likelihood of IMP. This patient eventually underwent laparoscopic enlarged right hemicolectomy due to recurrent symptoms and poor outcomes of non-surgical treatment. Postoperative pathological results confirmed the diagnosis of IMP. During the follow-up period, the patient recovered well without recurrence of IMP. Furthermore, we have reviewed the literature related to IMP and summarized the etiology, risk factors, diagnostic methods, treatment options and prognosis of IMP.
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Affiliation(s)
- Siyu Liu
- Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Yujun Tong
- Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Ruizi Shi
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xintao Zeng
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Hua Luo
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Pei Yang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xianfu Cai
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Decai Wang
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Huiwen Luo
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Jianjun Wang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
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Araki A, Ishizuka K, Uchida R, Ie K. Mesenteric phlebosclerosis caused by traditional Chinese herbal medicine. Postgrad Med J 2024; 100:519-520. [PMID: 38493357 DOI: 10.1093/postmj/qgae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Akiho Araki
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Ryuji Uchida
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Kenya Ie
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
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Wang M, Wan YX, Liao JW, Xiong F. Idiopathic mesenteric phlebosclerosis missed by a radiologist at initial diagnosis: A case report. World J Clin Cases 2024; 12:1810-1816. [PMID: 38660081 PMCID: PMC11036484 DOI: 10.12998/wjcc.v12.i10.1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/31/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Abstract
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.
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Affiliation(s)
- Min Wang
- Department of Gastroenterology, Changning County People’s Hospital, Yibin 644300, Sichuan Province, China
| | - Yu-Xia Wan
- Department of Gastroenterology, Qianwei People’s Hospital, Leshan 614400, Sichuan Province, China
| | - Jin-Wen Liao
- Department of Gastroenterology, The People’s Hospital of Jianyang City, Chengdu 641400, Sichuan Province, China
| | - Fei Xiong
- Department of Gastroenterology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China
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Zhang C, Huang H, Guo B. Idiopathic mesenteric phlebosclerosis occurring in a patient with liver cirrhosis: A case report. Medicine (Baltimore) 2024; 103:e37608. [PMID: 38489674 PMCID: PMC10939688 DOI: 10.1097/md.0000000000037608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Idiopathic mesenteric phlebosclerosis (IMP) is a rare gastrointestinal disease with unclear etiology and pathogenesis. IMP occurring in a patient with liver cirrhosis is more scarcely reported than independent IMP. In this study, we reported a case of IMP occurring in a patient with liver cirrhosis, so as to provide a reference for understanding liver cirrhosis with IMP. METHOD A 63-year-old man with liver cirrhosis was admitted in the hospital's department of infectious disease because of fatigue and constipation for 1 month. The patient had an irregular medical history of antivirus drug and Chinese herbal medicine intake because of the hepatitis B virus infection. No other abnormalities were found in the functions of the liver, coagulation, renal, or complete blood count. Fecal occult blood tests were all positive in 5 detections. Contrast-enhanced computed tomography revealed liver cirrhosis and showed thickening of the wall of the right hemicolon and multiple calcifications of the mesenteric veins. Mesenteric vein computed tomography venography displayed diffuse colon mural thickening of the right colon and tortuous linear calcification line in the right colic veins. Colonoscopy revealed a purple-blue, swollen, rough, and vanished vascular texture mucosa. He was finically diagnosed as liver cirrhosis with IMP by a series of examinations during hospitalization. RESULTS His symptoms of fatigue and constipation subsided after conservative treatment and withdraw from Chinese herbal medicine. The patient experienced no obvious discomfort during the follow-up period. CONCLUSION A comprehensive medical diagnosis is necessary for the discovery of IMP, especially IMP with liver cirrhosis. Liver cirrhosis maybe play a key role in the development of IMP. The regulatory mechanism of liver cirrhosis contributing to IMP needs to be further studied based on more clinical cases.
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Affiliation(s)
- Congjie Zhang
- Department of Dermatology, Center for Plastic and Reconstructive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Haijun Huang
- Department of Infectious Diseases, Center for General Practice Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Beibei Guo
- Department of Gastroenterology, Center for General Practice Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou Zhejiang, China
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Nishiwaki R, Inoue Y, Sugao M, Sugimasa N, Hamaguchi T, Noji M, Takeuchi K, Ito Y, Kato T, Yasuma T, D'Alessandoro-Gabazza CN, Gabazza EC, Imoto I. Hangeshashinto-Associated Mesenteric Phlebosclerosis and Highly Atypical Adenoma Requiring Laparoscopic Right Hemicolectomy. Diagnostics (Basel) 2024; 14:565. [PMID: 38473037 DOI: 10.3390/diagnostics14050565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/25/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
Mesenteric phlebosclerosis is a rare ischemic colonic disorder caused by impaired venous drainage. Its prevalence is higher in East Asia, where herbal medicine is widely used. Treatment remains controversial. A 76-year-old woman who had taken Hangeshashinto, an herbal medicine, for 11 years was admitted for endoscopic treatment of high-grade dysplasia in the ascending colon. She had diarrhea and mesenteric phlebosclerosis diagnosed by abdominal computed tomography at age 71. At age 75, small polyps were detected in the ascending colon. A subsequent study revealed an increase in polyp size to 15 mm. Endoscopic mucosal resection failed to remove the lesion. A biopsy showed high-grade dysplasia with possible colon cancer risk. Conservative therapy did not improve mesenteric phlebosclerosis-related diarrhea; therefore, a laparoscopic right hemicolectomy was performed. Intraoperatively, the cecum was adherent to the abdominal wall and the right ovary. The specimen showed high-grade dysplasia in the mucosa and severe submucosal fibrosis. No metastasis was observed. This case shows the link between mesenteric phlebosclerosis and high-grade dysplasia in the ascending colon. Endoscopic mucosal resection was unsuccessful in removing the tumor. Endoscopic submucosal dissection was an alternative, but its safety in mesenteric phlebosclerosis-affected colonic segments remains uncertain. A laparoscopic right hemicolectomy was performed.
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Affiliation(s)
- Ryo Nishiwaki
- Department of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, Japan
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Tsu 514-8507, Japan
| | - Yasuhiro Inoue
- Department of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, Japan
| | - Masataka Sugao
- Department of Internal Medicine, Doshinkai Tohyama Hospital, Tsu 514-0043, Japan
| | - Natsuko Sugimasa
- Department of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, Japan
| | - Tetsuya Hamaguchi
- Department of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, Japan
| | - Midori Noji
- Department of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, Japan
| | - Kenji Takeuchi
- Department of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, Japan
| | - Yoshiyuki Ito
- Department of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, Japan
| | - Toshio Kato
- Department of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, Japan
| | - Taro Yasuma
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Tsu 514-8507, Japan
| | | | - Esteban C Gabazza
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Tsu 514-8507, Japan
| | - Ichiro Imoto
- Digestive Endoscopy Center, Doshinkai Tohyama Hospital, Tsu 514-0043, Japan
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Wang PY, Weng KH, Liou JY, Kuo HT, Ho CH, Sheu MJ. Clinical significance of abdominal computed tomography and colonoscopy in the evaluation of phlebosclerotic colitis. Kaohsiung J Med Sci 2024; 40:296-303. [PMID: 37732706 DOI: 10.1002/kjm2.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/20/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
Clinical manifestations of phlebosclerotic colitis (PC) exhibit significant variability, necessitating diverse treatment strategies depending on disease severity. However, there is limited research exploring the relationship between imaging findings and disease severity. Hence, this retrospective study aimed to analyze the correlation between computed tomography (CT) findings, colonoscopic features, and disease severity. This study compared the abdominal CT characteristics, colonoscopy findings, and treatment modalities of 45 PC patients. CT images were assessed for the severity of mesenteric venous calcification, maximum colonic wall thickness, number of involved colonic segments, and presence of pericolic inflammation. Colonoscopic images were assessed for dark purple discoloration mucosa, erosive and ulcerative lesions, mucosal edema, luminal narrowing, and the number of involved colonic segments. In addition, patients were categorized into three groups: the observation (n = 15), medical treatment (n = 19), and operation (n = 11) groups. In CT images, a significant difference in pericolic inflammation (p = 0.039) was observed among groups. Further, significant differences in dark purple discoloration mucosa (p = 0.033), erosive or ulcerative lesions (p < 0.001), mucosal edema (p < 0.001), luminal narrowing (p = 0.012), and the number of involved colonic segments (p = 0.001) were observed in colonoscopy. Moreover, we found positive correlations between CT and colonoscopy features. In conclusion, CT manifestations and colonoscopy findings exhibited correlation with disease severity in PC. When limited to one diagnostic tool, observations from that tool can infer potential manifestations of the alternative tool.
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Affiliation(s)
- Pin-Yi Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Kung-Hsun Weng
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Jyun-Yan Liou
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsing-Tao Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Ming-Jen Sheu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
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Chen S, Zhu Y, Wu B, Xie X. Idiopathic mesenteric phlebosclerotic colitis associated with Chinese herbal medicine. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:170-171. [PMID: 37114414 DOI: 10.17235/reed.2023.9641/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Idiopathic mesenteric phlebosclerotic colitis(IMP) is a rare disease. At present, the etiology and pathogenesis are not clear, but the main patients are Asian people, and most of them have a history of taking Chinese herbal medicines. The disease has characteristic endoscopic and imaging manifestations. This paper shares a case of IMP, The patient came to our hospital for one year because of intermittent abdominal pain and diarrhea. It conforms to the typical manifestations of IMP. For patients who take Chinese herbal medicine for a long time, if they have clinical manifestations of gastrointestinal tract, it is necessary to consider the possibility of the disease to avoid serious consequences due to missed diagnosis.
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Affiliation(s)
- Shurong Chen
- Gastroenterology, Affiliated Hangzhou Xixi Hospital. Zhejiang University School of Medicine, People's Republic of China
| | - Yuandong Zhu
- Gastroenterology, Affiliated Hangzhou Xixi Hospital. Zhejiang University School of Medicine, People's Republic of China
| | - Bo Wu
- Gastroenterology, Affiliated Hangzhou Xixi Hospital. Zhejiang University School of Medicine, People's Republic of China
| | - Xincheng Xie
- Gastroenterology, Affiliated Hangzhou Xixi Hospital. Zhejiang University School of Medicine, People's Republic of China
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Liu C, Li L. Drug-related: A case of idiopathic mesenteric phlebosclerosis combined with calcification of the esophageal veins. JGH Open 2024; 8:e13027. [PMID: 38268963 PMCID: PMC10805477 DOI: 10.1002/jgh3.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
Idiopathic mesenteric phlebosclerosis (IMP) is characterized by mesenteric vein calcification and ischemic bowel disease. We describe a unique clinical case of IMP in a patient with a history of oral administration of various drugs, including traditional Chinese medicines (mainly selfheal), vitamin D, and calcium supplements. The disease was not diagnosed in its early stages and was later detected because of the initial symptoms of chest tightness and difficulties in swallowing. During medical examination, esophageal venous sinuses were found through gastroscopy, and CT revealed thickening and widespread calcification of the colonic wall (esophageal wall calcification). Moreover, typical purple-brown changes in the colonic mucosa were found during colonoscopy. Microscopic examination showed more foam phagocyte, focal lymphocyte aggregation, small-vessel proliferation, and surrounding collagen-like deposition which is a typical finding of IMP. More specifically, the patient's mesenteric veins and colon veins were calcified, and the calcification extended to the esophageal veins. These findings were related to long-term use of traditional Chinese medicines (mainly selfheal). It is possible that excessive intake vitamin D and calcium supplementation may have played a role in the occurrence of vascular calcification, which might have exacerbated the progression of IMP disease.
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Affiliation(s)
- Chang Liu
- Department of GastroenterologyPeople's Hospital of Chongqing Liang Jiang New AreaChongqingChina
| | - Li Li
- Department of GastroenterologyPeople's Hospital of Chongqing Liang Jiang New AreaChongqingChina
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Saito E, Ohtsuka K, Kawamoto A, Fujii T, Takenaka K, Hibiya S, Shimizu H, Nagahori M, Tomii S, Okamoto R. A case of venous stasis colitis possibly caused by eplerenone. Clin J Gastroenterol 2023; 16:69-72. [PMID: 36319777 DOI: 10.1007/s12328-022-01722-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/10/2022] [Indexed: 12/03/2022]
Abstract
A 50-year-old man was referred to our hospital for colitis with abdominal pain and diarrhea that had persisted for more than 8 months. 9 months earlier, he had been treated for fulminant eosinophilic myocarditis. During steroid therapy, ulceration appeared in the esophagus, stomach and large intestine. The biopsy results showed cytomegalovirus (CMV) inclusion bodies, and the patient was diagnosed with CMV gastrocolitis and treated with ganciclovir. Colonoscopy 7 months earlier revealed ischemia-like segmental colitis 10 cm in length in the hepatic flexure without evidence of CMV infection. Colonoscopy after 1 month and 3 months showed no improvement. We suspected drug-induced focal ischemic colitis, and discontinued eplerenone. Colonoscopy 2 months after withdrawal of eplerenone showed improvement in colitis, and colonoscopy 8 months later showed ulcer healing. Venous disorders are cautioned as a known side effect of eplerenone, but this is the first report of venous stasis colitis thought to be caused by eplerenone.
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Affiliation(s)
- Eiko Saito
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
| | - Ami Kawamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Shuji Hibiya
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Hiromichi Shimizu
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Masakazu Nagahori
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Shohei Tomii
- Division of Surgical Pathology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Ryuichi Okamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
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12
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Shan J, Chen F, Yu P. Intestinal obstruction due to idiopathic mesenteric phlebosclerosis colitis: A case report. Front Surg 2022; 9:969154. [PMID: 36061039 PMCID: PMC9428392 DOI: 10.3389/fsurg.2022.969154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Idiopathic mesenteric phlebosclerosis colitis (IMP) is a rare condition that impairs colonic venous blood return owing to mesenteric venous sclerosis and fibrosis. At present, many studies have suggested that long-term intake of Chinese herbal medicines is associated with its pathogenesis. IMP has no characteristic clinical manifestations, and most patients with IMP present with acute intestinal obstruction. As a rare disease, the etiology, pathogenesis, pathophysiology, and treatment of IMP are being explored and studied. Case Description A 60-year-old Chinese male patient with IMP was admitted to our hospital for acute intestinal obstruction, received subtotal colectomy and ileostomy after 10 days of ineffective conservative treatment, and was discharged after postoperative supportive treatment for 1 month. Conclusion There are many causes of intestinal obstruction, and we report a relatively rare one. After failure of conservative treatment, it is necessary to surgically resect part of the diseased bowel.
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Affiliation(s)
- Jiaqi Shan
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fangci Chen
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Panpan Yu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Gastrointestinal Surgery, Hangzhou First People’s Hospital, The Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
- Correspondence: Panpan Yu
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Widespread mesenteric phlebosclerosis presenting as intestinal obstruction due to stenosis of the right-sided colon. Clin J Gastroenterol 2022; 15:717-721. [PMID: 35489002 DOI: 10.1007/s12328-022-01637-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/16/2022] [Indexed: 02/07/2023]
Abstract
Mesenteric phlebosclerosis is a rare form of intestinal ischemia characterized by thickening of the right-sided colon and calcification of the mesenteric vein. We describe the case of a 58-year-old woman admitted to our hospital because of abdominal pain and distension. An abdominal computed tomography study revealed remarkable dilatation and fluid collection of the small intestine compatible with intestinal obstruction, which was considered to be the result of stenosis of the ascending colon. The thickened wall of the cecum and ascending colon was associated with calcification of the colonic wall and mesenteric veins. Colonoscopy showed dark purple discoloration of the edematous mucosa from the splenic flexure through the hepatic flexure, at which point the colonoscope could not be advanced further because of stenosis of the ascending colon. Over 10 years previously, the patient had taken an herbal medicine containing gardenia fruit, which can cause mesenteric phlebosclerosis. An extensive colonic resection was performed after intestinal decompression. This case highlights extensive mesenteric phlebosclerosis causing intestinal obstruction from the cecum through the proximal portion of the sigmoid colon, which was treated with extensive colonic resection.
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14
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Jin YR, Zhou H, Liu ZZ, Li XF, Liang J. Idiopathic mesenteric phlebosclerosis occurring after long-term medication with licorice: A case report. J Dig Dis 2022; 23:183-185. [PMID: 35156308 DOI: 10.1111/1751-2980.13087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/17/2022] [Accepted: 02/11/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Yi Rong Jin
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, Shaanxi Province, China
| | - He Zhou
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, Shaanxi Province, China
| | - Zhen Zhen Liu
- Digestive Disease Department, Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, Shaanxi Province, China
| | - Xiao Fei Li
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, Shaanxi Province, China
| | - Jie Liang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, Shaanxi Province, China
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15
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Ko SF, Chen HH, Huang CC, Lin LH, Ng SH, Lee YW. Phlebosclerotic colitis: an analysis of clinical and CT findings in 29 patients with long-term follow-up. Insights Imaging 2022; 13:19. [PMID: 35092508 PMCID: PMC8800981 DOI: 10.1186/s13244-022-01159-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background Phlebosclerotic colitis (PC) is a rare form of nonthrombotic colonic ischemia. This retrospective study analyzed the clinical findings and temporal CT changes in 29 PC patients with long-term follow-up. Methods Twenty-nine patients with characteristic CT features of PC collected between 1997 and 2020 were stratified into the acute abdomen group (AA-group) (n = 10), chronic-progressive group (CP-group) (n = 14) and chronic-stable group (CS-group) (n = 5). Clinical and CT changes during follow-up, comorbidities and final outcomes were compared. Results The AA-group exhibited a significantly thicker colonic wall and more involved segments and pericolic inflammation than the CP-group and CS-group on initial CT (p = < 0.001–0.031). Seven patients in the AA-group who underwent right hemicolectomy had no recurrence during follow-up (mean ± SD, 7.1 ± 3.3 years), and the remaining three patients with renal or hepatic comorbidities who underwent conservative treatment died within 14 days. The CP-group showed significantly higher frequencies of chronic renal failure, urinary tract malignancies and liver cirrhosis than the AA-group (p = 0.005–0.008). In addition, CT follow-up (7.9 ± 4.3 years) showed significant increases in mesenteric venous calcifications, colonic wall thickening and involved colonic segments (p = 0.001–0.008) but conservative treatments were effective. The CS-group remained unchanged for years (8.2 ± 3.9 years). Conclusions Early surgery offered excellent prognosis in PC-related acute abdomen denoted by marked right colonic wall thickening and pericolic inflammation on CT. Conservative treatments with a wait-and-watch strategy were appropriate for CP-PC and CS-PC, albeit CP-PC harbored significant increases in calcifications, colonic wall thickening and affected segments in long-term CT follow-up.
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16
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Nakamura T, Fujiwara M, Hara K, Kurosawa K, Miyazaki T. Phosphoglyceride crystal deposition disease involving adnexa uteri: a case report with histogenetic consideration. Pathologica 2022; 113:442-448. [PMID: 34974550 PMCID: PMC8720398 DOI: 10.32074/1591-951x-193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022] Open
Abstract
We present a rare case of phosphoglyceride crystal deposition disease (PCDD), as a gynecologic disease, with reference to histogenesis of crystal deposition. An 84-year-old woman, who had undergone simple hysterectomy for uterine leiomyoma 44 years previously, presented with multiple masses in the bilateral adnexa and the pelvic wall. The bilateral adnexal tumors were resected. The masses histologically revealed a foreign-body granuloma composed of numerous tiny, radially arranged needle-like crystal lumps surrounded by multinucleated giant cells and macrophages. The crystals showed birefringence under polarized light and were positive for gold hydroxamic acid stain, and the tumor was thus diagnosed as PCDD. The masses revealed central cystic changes due to old hemorrhage, which contained crystal lumps without foreign-body reaction or birefringence. The present case demonstrated for the first time that phosphoglyceride crystals developed in old hemorrhagic foci, although it was not confirmed whether the old hemorrhagic foci were formed after hysterectomy or due to endometriosis.
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Affiliation(s)
| | - Masayuki Fujiwara
- Department of Diagnostic Pathology, Ina Central Hospital, Ina, Japan.,Department of Laboratory Medicine, Ina Central Hospital, Ina, Japan
| | - Kikue Hara
- Department of Obstetrics and Gynecology, Ina Central Hospital, Ina, Japan
| | - Kazuko Kurosawa
- Department of Obstetrics and Gynecology, Ina Central Hospital, Ina, Japan
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17
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Mesenteric phlebosclerosis associated with the oral intake of Japanese traditional (Kampo) medicines containing Gardeniae Fructus. Clin J Gastroenterol 2021; 14:1453-1458. [PMID: 34341949 DOI: 10.1007/s12328-021-01490-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/24/2021] [Indexed: 11/09/2022]
Abstract
We report a case of mesenteric phlebosclerosis (MP) in a woman in her 50s who had been taking Kamishoyosan for 13 years. Colonoscopic findings 13 years after the start of oral administration were nonspecific, with decreased vascular permeability and redness of the mucosa. The extent of the lesion was initially from the cecum to the ascending colon but expanded over time to the transverse colon. In colon biopsies, there was a remarkable deposition of collagen fibers around the small vessels in the lamina propria of the cecum or the ascending colon over time, and the specific lesions expanded to the transverse colon. The deposition of collagen fibers around the vessels in the lamina propria was already present when the total oral dose of the Sanshishi component was low. In this valuable case of MP, changes after the start of oral administration of Kamishoyosan could be followed over time via endoscopy and biopsy.
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18
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Ding J, Zhang W, Wang L, Zhu Z, Wang J, Ma J. Idiopathic mesenteric phlebosclerosis: clinical and CT imaging characteristics. Quant Imaging Med Surg 2021; 11:763-771. [PMID: 33532275 DOI: 10.21037/qims-20-301] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The aim of our study was to evaluate the clinical characteristics and computed tomography (CT) imaging findings of idiopathic mesenteric phlebosclerosis (IMP). Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Jian Ding
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Weiqiang Zhang
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Lizhang Wang
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zefeng Zhu
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jia Wang
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jianbing Ma
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
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19
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Kubo K, Kimura N, Maiya N, Matsuda S, Tsuda M, Kato M. Mesenteric Phlebosclerosis Associated with Herbal Medicine. Case Rep Gastroenterol 2020; 14:516-521. [PMID: 33250691 PMCID: PMC7670342 DOI: 10.1159/000508931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022] Open
Abstract
Mesenteric phlebosclerosis (MP) associated with herbal medicine is rarely reported and its endoscopic and radiological features remain poorly described. An 81-year-old woman was admitted to our hospital for right lower abdominal pain and high-grade fever. Computed tomography (CT) revealed wall thickening, pericolic fat stranding, and linear calcifications extending from the cecum to the hepatic flexure of the colon. Ultrasonography (US) revealed wall thickening of the cecum and ascending colon. Colonoscopy (CS) revealed dark-purple edematous mucosa with erosion and ulcers from the cecum to the hepatic flexure of the colon. The patient was histopathologically diagnosed with MP, discontinued orengedokuto, and was treated with intravenous antibiotics for 1 week. Six months after treatment, US and CT revealed no significant changes, but CS showed improvement in dark-purple edematous mucosa with erosion and ulcers. To our knowledge, this report represents a valuable addition to the MP literature describing a rare case of MP associated with herbal medicine.
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Affiliation(s)
- Kimitoshi Kubo
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Noriko Kimura
- Department of Pathology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Norishige Maiya
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Soichiro Matsuda
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Momoko Tsuda
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
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20
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Wen Y, Zhao M, Huang W, Fang S, Lin C. Idiopathic mesenteric phlebosclerosis associated with use of Chinese herbal medicine: Two case reports. Medicine (Baltimore) 2020; 99:e22813. [PMID: 33080758 PMCID: PMC7571907 DOI: 10.1097/md.0000000000022813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Idiopathic mesenteric phlebosclerosis (IMP) is a rare form of ischemic colitis. It is more common in the Asian population people with Asian ancestry. Disease pathogenesis and etiology are not fully elucidated but may be associated with the long-term intake of toxins and other substances, including Chinese herbs. The disease has typical radiological and endoscopic features. Radiologic examination combined with endoscopy can lead to a conclusive diagnosis. PATIENT CONCERNS We present 2 cases of IMP: in male patients aged 66 and 79 years. The first patient presented with diarrhea and abdominal pain, and the second patient presented with numbness of limbs and abdominal discomfort. These patients had a history of long-term use of Chinese herbal medicine (CHM). DIAGNOSIS Both patients were diagnosed with IMP by endoscopy and radiology, and the diagnosis confirmed by biopsy in the first patient. INTERVENTIONS The first patient was advised to stop using CHM. Both patients were given conservative treatment and were followed up regularly. OUTCOMES Symptoms improved after conservative treatment. The patients had no obvious discomfort during the follow-up period. CONCLUSION We suspect that the disease is induced by the long-term use of CHM, and dosage and duration of use may determine disease severity.
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Affiliation(s)
| | | | - Wei Huang
- Departments of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
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21
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Xu J, Jin M, Jiang Z, Ke Q, Li A, Zhu T, Lai M. Clinicopathological features of phlebosclerotic colitis. Pathol Res Pract 2020; 216:153193. [PMID: 32927306 DOI: 10.1016/j.prp.2020.153193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/23/2020] [Accepted: 08/23/2020] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Jing Xu
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, PR China
| | - Mei Jin
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, PR China
| | - Zhinong Jiang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, PR China
| | - Qinbing Ke
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, PR China
| | - Aiqing Li
- Departmentof Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, PR China
| | - Tao Zhu
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, PR China
| | - Maode Lai
- Department of Pathology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, PR China.
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22
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Kawasaki K, Eizuka M, Kudara N, Yanai S, Toya Y, Torisu T, Umeno J, Nakamura S, Sugai T, Matsumoto T. Mesenteric phlebosclerosis complicating colonic cancer treated by endoscopic submucosal dissection. Clin J Gastroenterol 2020; 13:1183-1188. [PMID: 32803642 DOI: 10.1007/s12328-020-01205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
A 67-year old woman with a history of long-term Chinese herb use was admitted to our institution complaining of abdominal pain. Barium enema disclosed rigidity of throughout the proximal colon and a slightly elevated lesion in the transverse colon. Colonoscopy showed diffuse and bronze mucosa in the proximal colon, which was compatible with mesenteric phlebosclerosis. There was also a reddish, elevated lesion in the transverse colon. Magnifying colonoscopy revealed irregular microsurface and microvessels on the surface of the lesion. Under a diagnosis of intramucosal cancer, the elevated lesion was treated by endoscopic submucosal dissection. Histological examination of the resected specimen showed intramucosal well-differentiated adenocarcinoma, and fibrous thickening of the vascular wall together with collagen deposition in the submucosa. The final diagnosis was an intramucosal cancer occurring in mesenteric phlebosclerosis.
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Affiliation(s)
- Keisuke Kawasaki
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Idaidori 2-1-1, Yahaba, 028-3695, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Makoto Eizuka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Norihiko Kudara
- Division of Gastroenterology, Iwate Prefectural Ofunato Hospital, Ofunato, Japan
| | - Shunichi Yanai
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Idaidori 2-1-1, Yahaba, 028-3695, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Idaidori 2-1-1, Yahaba, 028-3695, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shotaro Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Idaidori 2-1-1, Yahaba, 028-3695, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Idaidori 2-1-1, Yahaba, 028-3695, Japan
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Effects of Long-Term Administration of Gardeniae Fructus on Intra-Abdominal Organs of Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4201508. [PMID: 32595727 PMCID: PMC7301247 DOI: 10.1155/2020/4201508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 12/24/2022]
Abstract
Many recent reports have suggested a possible association between Japanese traditional (Kampo) medicines containing Gardeniae Fructus (GF, the fruit of Gardenia jasminoides J. Ellis) and the mesenteric phlebosclerosis (MP). MP is a chronic orphan disease characterized by venous calcification extending from the colonic wall to the mesentery, usually developing in the proximal colon. In the present study, we administered GF to Wistar/ST female rats as 1% and 2% feed in the diet for 11 months to evaluate any calcification and/or fibrosis of veins in the colonic wall and mesentery. The reversibility of GF's effects was examined by feeding a normal diet for an additional 3 months. A significant decrease in body weight gain and food consumption occurred in the 2% GF group. Pigmentation of the liver, kidney, and spleen in macroscopic or histopathological examination was observed after 11-month administration, which disappeared after the 3-month recovery period. Histopathological findings such as fibrous thickening and calcification of vein walls, characteristic of human MP, were not observed. Fibrosis in the colonic lamina propria was observed in the 2% GF group but not in the 1% GF group during the treatment period, but the incidence as well as grade of this type of fibrosis decreased in the recovery period, suggesting that the effects of GF were reversible. In the present study, chronic GF administration did not result in any venous pathological changes but induced pigmentation in the liver, kidneys, and spleen and moderate fibrosis in the colonic lamina propria, all of which being reversible. Further studies are required to determine the association between GF and MP.
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Takahashi J, Miyakura Y, Maemoto R, Takayama N, Fukuda R, Tamaki S, Ishikawa H, Tsujinaka S, Lefor AK, Rikiyama T. Idiopathic mesenteric phlebosclerosis treated with laparoscopic subtotal colectomy: A case report. Asian J Endosc Surg 2020; 13:223-226. [PMID: 31240856 DOI: 10.1111/ases.12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/11/2019] [Accepted: 05/20/2019] [Indexed: 12/24/2022]
Abstract
Idiopathic mesenteric phlebosclerosis is a rare entity characterized by chronic intestinal ischemia due to calcification and obstruction of the mesenteric veins. Here, we report a patient with idiopathic mesenteric phlebosclerosis treated with laparoscopic subtotal colectomy after evaluation by imaging studies. The patient was a 68-year-old Japanese woman with recurrent abdominal pain who had taken a Chinese herbal medicine for more than 20 years. Abdominal CT showed wall thickening of the right colon with calcification of branches of the superior mesenteric vein. Colonoscopy showed cyanotic mucosa from the cecum to the sigmoid colon. The affected area seen on colonoscopy extended to the distal colon. Despite discontinuation of the herbal medicine, her symptoms did not improve. Laparoscopic subtotal colectomy was performed. This report highlights the importance of appropriately evaluating the extent of the affected preoperatively area based on findings from colonoscopy, CT, and contrast enema.
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Affiliation(s)
- Jun Takahashi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryo Maemoto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Noriya Takayama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Rintaro Fukuda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sawako Tamaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideki Ishikawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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25
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Hu YB, Hu ML, Ding J, Wang QY, Yang XY. Mesenteric phlebosclerosis with amyloidosis in association with the long-term use of medicinal liquor: A case report. World J Clin Cases 2020; 8:798-805. [PMID: 32149063 PMCID: PMC7052551 DOI: 10.12998/wjcc.v8.i4.798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 02/05/2023] Open
Abstract
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 mainland China.
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.
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Affiliation(s)
- Yi-Bing Hu
- Department of Gastroenterology and Hepatology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang Province, China
| | - Min-Li Hu
- Department of Gastroenterology and Hepatology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang Province, China
| | - Jin Ding
- Department of Gastroenterology and Hepatology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang Province, China
| | - Qun-Ying Wang
- Department of Gastroenterology and Hepatology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang Province, China
| | - Xiao-Yun Yang
- Department of Gastroenterology and Hepatology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang Province, China
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26
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Mathew RP, Girgis S, Wells M, Low G. Phlebosclerotic Colitis - An Enigma Among Ischemic Colitis. J Clin Imaging Sci 2019; 9:18. [PMID: 31448169 PMCID: PMC6702870 DOI: 10.25259/jcis-30-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/26/2019] [Indexed: 12/11/2022] Open
Abstract
Phlebosclerotic Colitis is a rare, potentially life-threatening condition of unclear etio-pathogenesis seen almost exclusively in Asians and people of Asian descent. The condition predominantly affects the right hemicolon and imaging plays a crucial role in its diagnosis. Here we report the only second documented case of phlebosclerotic colitis in North America in a 60-year-old Canadian resident of Vietnamese descent with a history of consuming herbal medication (sanshishi) in soup for 2-3 decades.
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Affiliation(s)
- Rishi Philip Mathew
- Departments of Radiology and Diagnostic Imaging, Division of Gastroenterology, University of Alberta, 8440 112 St NW, Edmonton, Canada
| | - Safwat Girgis
- Departments of Laboratory Medicine and Pathology, Division of Gastroenterology, University of Alberta, 8440 112 St NW, Edmonton, Canada
| | - Malcolm Wells
- Department of Medicine, Division of Gastroenterology, University of Alberta, 8440 112 St NW, Edmonton, Canada
| | - Gavin Low
- Departments of Radiology and Diagnostic Imaging, Division of Gastroenterology, University of Alberta, 8440 112 St NW, Edmonton, Canada
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27
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Yoshida T, Homma S, Ohno Y, Ichikawa N, Kawamura H, Sato R, Ohta T, Imamoto T, Matsuno Y, Taketomi A. Laparoscopic Surgery for the Treatment of Mesenteric Phlebosclerosis. Am Surg 2018. [DOI: 10.1177/000313481808401216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tadashi Yoshida
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Yosuke Ohno
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Hideki Kawamura
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Ryo Sato
- Gastroenterology Center Sapporo Higashi Tokushukai Hospital Sapporo, Japan
| | - Tomoyuki Ohta
- Gastroenterology Center Sapporo Higashi Tokushukai Hospital Sapporo, Japan
| | - Teppei Imamoto
- Surgical Pathology Hokkaido University Hospital Sapporo, Japan
| | | | - Akinobu Taketomi
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo, Japan
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28
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Matsuno Y, Hirano A, Esaki M. Possible Association of Phlebitis-Induced Colitis With Indigo Naturalis. Gastroenterology 2018; 155:576-577. [PMID: 30064721 DOI: 10.1053/j.gastro.2018.01.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 01/18/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Yuichi Matsuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Hirano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motohiro Esaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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29
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Ichimata S, Aoyagi D, Kobayashi M, Sugihara T, Nishio A, Maruyama M, Shiozawa S. Early-stage idiopathic mesenteric phlebosclerosis incidentally combined with adenocarcinoma of the ascending colon: A report of two cases. Pathol Int 2017; 68:139-141. [PMID: 29280316 DOI: 10.1111/pin.12614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/04/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Shojiro Ichimata
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Pathology, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Daiju Aoyagi
- Department of Pathology, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Mikiko Kobayashi
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Pathology, Nagano Red Cross Hospital, Nagano, Japan
| | - Takehiko Sugihara
- Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Akihito Nishio
- Department of Gastroenterological Surgery, Nagano Red Cross Hospital, Nagano, Japan
| | - Masafumi Maruyama
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Satoshi Shiozawa
- Department of Pathology, Saku Central Hospital Advanced Care Center, Saku, Japan
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30
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Ascending colon cancer coincident with mesenteric phlebosclerosis associated with the long-term oral intake of Chinese herb containing gardenia fruit: A case report and literature review. Int Cancer Conf J 2017; 6:70-75. [PMID: 31149474 DOI: 10.1007/s13691-017-0277-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/05/2017] [Indexed: 12/24/2022] Open
Abstract
Mesenteric phlebosclerosis is a recently discovered rare ischemic colon disease. The relationship between mesenteric phlebosclerosis and the use of herbal medicine containing gardenia fruit was recently reported. Although the relationship between colon cancer and mesenteric phlebosclerosis has not been described, some cases of colorectal cancer coincident with mesenteric phlebosclerosis have been reported. We treated a 63-year-old female who was diagnosed with ascending colon cancer coincident with mesenteric phlebosclerosis. She had been taking a Chinese herb containing gardenia fruit for over 18 years. The ascending colon cancer was clinically diagnosed as T2, N0, and M0 according to Japanese classification of colorectal carcinoma and the mesenteric phlebosclerosis had spread from the cecum to the descending colon. She underwent laparoscopic subtotal colectomy with en bloc removal of the regional lymph nodes, and both the ascending colon cancer and mesenteric phlebosclerosis were completely resected. The microscopic findings show that the tumor was well-differentiated tubular adenocarcinoma invading the muscular propria with no regional lymph node metastasis, and the mesenteric phlebosclerosis lesion was characterized by marked fibrous thickening of the venous walls with calcification, marked transmural fibrosis and deposition of the collagen in the mucosa, accompanied by macrophages within the vessel walls. In literature review, 10 cases with colorectal cancer coincident with mesenteric phlebosclerosis were reported. 9 of 10 cases (90%) had cancer in the right-side colon affected by mesenteric phlebosclerosis, and 5 of 10 cases (50%) were associated with the use of a Chinese herb containing gardenia fruit. It was recently demonstrated that genipin, which is a metabolite bio-transformed from gardenia fruit, possesses carcinogenesis. We speculate that genipin may be associated with not only the development of mesenteric phlebosclerosis but also carcinogenesis in the right-side colon. In conclusion, our findings suggest that the safety of gardenia fruit should be re-evaluated, and gastroenterologists should be aware that gardenia fruit may be risk factor for not only the development of mesenteric phlebosclerosis but also carcinogenesis in the proximal colon.
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