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Enterocolic Lymphocytic Phlebitis Treated Preoperatively with Biologics and Immunosuppressive Agents. Case Rep Pathol 2022; 2022:5120607. [PMID: 35295675 PMCID: PMC8920688 DOI: 10.1155/2022/5120607] [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: 11/18/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Enterocolic lymphocytic phlebitis is phlebitis of unknown etiology in which lymphocytes affect veins without arteries and shows evidence of systemic vasculitis in the intestinal wall and mesentery, mainly in the small intestine and colon. Although patients present with a variety of gastrointestinal symptoms and findings like those of inflammatory bowel disease or ischemic bowel disease, there are no specific findings for enterocolic lymphocytic phlebitis. As a result, a diagnosis tends to be made after surgery. There are few case reports of enterocolic lymphocytic phlebitis, and the impact of chronic courses and immunosuppressive drugs on enterocolic lymphocytic phlebitis is not well known. A 47-year-old man was treated with infliximab and steroids for unexplained ulceration and narrowing of the ileocecal area, which was suspected to be inflammatory bowel disease with atypical findings. Lymphocytic phlebitis was noted in the surgical specimen, and enterocolic lymphocytic phlebitis was diagnosed. No recurrence of enterocolic lymphocytic phlebitis was observed postoperatively. This disease should also be considered among patients with inflammatory bowel disease-like lesions that do not respond to infliximab or steroids.
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Dal Buono A, Carvello M, Sachar DB, Spinelli A, Danese S, Roda G. Diversion proctocolitis and the problem of the forgotten rectum in inflammatory bowel diseases: A systematic review. United European Gastroenterol J 2021; 9:1157-1167. [PMID: 34845854 PMCID: PMC8672074 DOI: 10.1002/ueg2.12175] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aims Diversion proctocolitis (DP) is a non‐specific mucosal inflammation arising in the defunctionalized colon and/or rectum following faecal diversion (colostomy, ileostomy). Differential diagnosis of DP from the underlying disease in patients with inflammatory bowel diseases (IBD) is often unclear. As a result, it might be difficult to undertake any specific treatment. We aimed to systematically review the literature evidence on DP in IBD patients. Methods For this qualitative systematic review, we searched PubMed, EMBASE and Scopus to identify all studies published until July 2021 including IBD patients affected by DP. Results Overall, 37 papers published between 1982 and 2021 were included. A total of 1.211 IBD patients were included: 613 UC (50.6%), 524 CD (43.3%), 66 IBD‐unclassified (IBD‐U) (5.4%), 8 unspecified patients (0.7%). Most patients with DP are asymptomatic, although inflammation is detectable in almost all patients with a rectal stump. Reduced short‐chain fatty acids and an altered microbiome, may trigger mucosal inflammation and have been proposed as causing factors. An increased risk of developing cancer on DP has been reported in patients with a history of previous dysplasia/cancer. Conclusions The etiopathogenesis of DP is still unknown. The efficacy of mesalamine, corticosteroids or short‐chain fatty acids has not been proven by randomized trials yet. Since the incidence of cancer of the rectal stump can reach 4.5 per 1.000 diverted patients‐year, IBD patients undergoing subtotal colectomy with end‐ileostomy should undergo close endoscopic surveillance, being eventually counseled for surgery with or without the restoration of the intestinal continuity.
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Affiliation(s)
- Arianna Dal Buono
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy
| | - Michele Carvello
- Colon and Rectal Surgery Division, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - David B Sachar
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Antonino Spinelli
- Colon and Rectal Surgery Division, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Roda
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy
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Nasher O, Alizai N. Enterocolic lymphocytic phlebitis: a rare pathology in children. BMJ Case Rep 2021; 14:e243826. [PMID: 34426428 PMCID: PMC8383883 DOI: 10.1136/bcr-2021-243826] [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] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
Enterocolic lymphocytic phlebitis (ELP) is a rare pathology, usually seen in the adult population. The condition affects the venous vasculature of the intestine sparing the arteries and lymphatics. It is commonly identified histologically after surgical resection making the preoperative diagnosis a clinical challenge. As the condition can lead to intestinal ischaemia and necrosis, surgical resection of the affected segment is the treatment of choice. We report the case of a 9-year-old girl who presented with a 2-day history of lower abdominal pain and anorexia. The initial diagnosis of appendicitis was made clinically and the patient underwent a diagnostic laparoscopy . The appendix was macroscopically normal and there were no other obvious intra-abdominal pathologies to account for her presenting complaints . The appendix was removed, as per the preoperative discussion and consent from parents. She recovered well and was discharged home the following day. The histological examination of the appendix demonstrated ELP. We describe this rare clinical entity in a child especially in view of the scarce published literature in the paediatric population.
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Affiliation(s)
- Omar Nasher
- Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Naved Alizai
- Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Huiberts AAM, Donkervoort SC, Blok WL, Blaauwgeers HLG. Enterocolic lymphocytic phlebitis: an oncologic surgical resection without a preoperative pathologic diagnosis. J Surg Case Rep 2014; 2014:rju037. [PMID: 24876508 PMCID: PMC4021381 DOI: 10.1093/jscr/rju037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A patient with complaints of an abdominal (mesenteric) mass is presented. Differential diagnosis included neoplastic processes, such as malignant lymphoma, desmoid tumour, a carcinoid or a gastro-intestinal stromal cell tumour. An oncological resection was performed. Despite the malignant appearance of the tumour no malignancy was found with histopathological examination. Vasculitic lesions were seen in venous structures, resembling veno-occlusive disease with signs of recanalization and with the presence of inflammatory cells, mainly lymphocytes. A diagnosis of enterocolic lymphocytic phlebitis was made. This benign condition can mimic malignancy, necessitating a wide excision, also because obtaining a pre-operative histopathological diagnosis is hardly possible.
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Affiliation(s)
| | | | - Willem L Blok
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
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Abstract
Ischemia is a common type of gastrointestinal injury that can be clinically misdiagnosed due to its often mild and transient clinical presentation as well as a tendency to masquerade as other disorders. A wide range of etiologies can contribute to the development of ischemia. These include hypovolemic states, systemic diseases such as vasculitis and hypercoagulable states, mechanical obstruction, therapeutic drug effects, infection, and a host of other diseases. An accurate diagnosis of ischemia relies on a strong clinical suspicion in combination with endoscopic and pathologic findings. Most cases show histologic features that are diagnostic of ischemia, but do not point to a specific differential diagnosis, whereas the cause of ischemia can be recognized or suspected based on careful review of vascular changes in others. This review is focused on providing an overview of ischemic enterocolitis and its differential diagnosis.
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Affiliation(s)
- Georgina Uberti
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, Ohio
| | - John R Goldblum
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, Ohio
| | - Daniela S Allende
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, Ohio.
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Seo MR, Kim TE, Ryu HJ, Baek HJ, Choi HJ. A Case of Enterocolic Lymphocytic Phlebitis Mimicking Surgical Abdomen. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.2.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Mi Ryoung Seo
- Division of Rheumatology, Department of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea
| | - Tae Eun Kim
- Department of Pathology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Jung Ryu
- Division of Rheumatology, Department of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea
| | - Hyo Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea
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Kim M, Lee HJ, Yeo MK, Lee YS, Moon HS, Lee SI, Cho JS, Song KS. Lymphocytic Phlebitis of the Stomach - A Case Report with Literature Review -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.6.654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Meeran Kim
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun-Jung Lee
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Min-Kyung Yeo
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young-Suk Lee
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hee Seok Moon
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang-Il Lee
- Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - June-Sik Cho
- Department of Radiology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kyu-Sang Song
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
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