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Deng X, Tang X, Yao H, Wang Y. Severe Venous Calcifications in Phlebosclerotic Colitis and Significantly Decreased Expression in Betaine. Int J Surg Pathol 2024:10668969241246475. [PMID: 38646813 DOI: 10.1177/10668969241246475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Phlebosclerotic colitis (PC) is a rare type of chronic ischemic colitis. Its etiology is still unknown, and PC is also known as idiopathic mesenteric phlebosclerosis colitis. Currently, many studies have reported that long-term use of Chinese herbal medicine and drinking history are related to its pathogenesis. In the early stage of the lesion, due to insufficient understanding of PC, it is difficult to distinguish it from inflammatory bowel disease and other nonneoplastic intestinal diseases. We reported a case of severe diffuse total colon calcification with multiple misdiagnosis, summarizing and analyzing the clinical pathological characteristics to increase clinical and pathological physicians' understanding of the disease and reduce misdiagnosis. Moreover, for the first time, we conducted metabolomics sequencing on fresh intestinal specimens of PC, in order to explore the possible mechanism of severe calcification in the patient. We found that betaine was significantly decreased in the intestinal specimens of the patient, which is an amino acid that has been shown to improve vascular risk factors, and may be one of the mechanisms underlying severe calcification in the patient.
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Affiliation(s)
- Xue Deng
- Chongqing Medical University, Chongqing, China
- Department of Pathology, The Chongqing General Hospital, Chongqing, China
| | - Xuefeng Tang
- Chongqing Medical University, Chongqing, China
- Department of Pathology, The Chongqing General Hospital, Chongqing, China
| | - Hui Yao
- Department of Pathology, The Chongqing General Hospital, Chongqing, China
| | - Ying Wang
- Department of Pathology, The Chongqing General Hospital, Chongqing, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chou JW, Chang CH, Wu YH, Chang KC, Cheng KS, Huang PJ. Idiopathic Mesenteric Phlebosclerosis: A Single-Institute Experience in Taiwan. Turk J Gastroenterol 2023; 34:483-489. [PMID: 36789983 PMCID: PMC10334683 DOI: 10.5152/tjg.2023.22335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/26/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Idiopathic mesenteric phlebosclerosis is a rare condition with unclear pathogenesis. This study aimed to investigate the clinical features, diagnostic modalities, treatments, and outcomes of idiopathic mesenteric phlebosclerosis patients in Taiwan. METHODS Idiopathic mesenteric phlebosclerosis patients diagnosed by the typical characteristic of tree-like mesenteric venous calcifications on plain abdominal radiography or computed tomography between January 1992 and July 2021 were retrospectively analyzed. RESULTS Totally, 36 idiopathic mesenteric phlebosclerosis patients were enrolled (50% females; mean age, 61.6 years). Among the included patients, 26 (72.2%) and 10 (27.7%) were symptomatic and asymptomatic, respectively. Abdominal pain (61.1%) accounted for the majority of all symptoms, followed by fever, diarrhea, and bloody stools. Our results showed that 83.3% of patients had at least 1 risk factor, whereas 16.6% of patients had none. Moreover, among the included patients, 36.1%, 44.4%, 50.0%, 38.8%, and 8.3% had cardiovascular disease, chronic renal disease, cancer, chronic liver disease, and diabetes mellitus, respectively. Our findings showed 94.4% of patients were diagnosed via abdominal computed tomography and plain abdominal radiography, whereas 5.6% of patients were diagnosed via plain abdominal radiography. The ascending colon was the most commonly involved site (100%). Our findings showed that 91.6% of patients experienced good recovery after conservative treatment, except for the 3 who died of sepsis and respiratory failure. By contrast, 8.3% of idiopathic mesenteric phlebosclerosis patients underwent colectomy. The average follow-up duration was 62.5 months. CONCLUSIONS Idiopathic mesenteric phlebosclerosis remains a rare disease in Taiwan. Plain abdominal radiography and computed tomography can be utilized for establishing a definite diagnosis. Conservative treatment is usually adequate for most patients, with surgical treatment only indicated for severe cases.
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Affiliation(s)
- Jen-Wei Chou
- China Medical University Faculty of Medicine, Taichung, Taiwan
- Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan
- Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Touyuan, Taiwan
| | - Chia-Hsi Chang
- Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Touyuan, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan
| | - Yi-Hua Wu
- Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan
- Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Touyuan, Taiwan
| | - Kai-Chih Chang
- Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ken-Sheng Cheng
- China Medical University Faculty of Medicine, Taichung, Taiwan
- Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Po-Ju Huang
- Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan
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Watanabe A, Kadowaki Y, Hattori K, Ohmori M, Tsukayama H, Kubota N, Okumoto T, Ishido N, Okino T. A Case of Primary Colonic Signet Ring Cell Carcinoma in a Young Man which Preoperatively Mimicked Phlebosclerotic Colitis. Acta Med Okayama 2019; 73:361-365. [PMID: 31439960 DOI: 10.18926/amo/56939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 35-year-old man was referred to our hospital for chronic abdominal pain and diarrhea. Computed tomography showed wall thickening, poor contrast enhancement and calcification of the ascending colon, which were consistent with phlebosclerotic colitis. Malignant character was not detected from a biopsy specimen. Operatively, we observed a scirrhous mass of the ascending colon invading surrounding tissue, which was diagnosed as signet ring cell carcinoma based on analysis of an intraoperative frozen section. Right hemicolectomy with regional lymph node dissection was performed. This case was extremely similar to phlebosclerotic colitis in clinical findings; surgical resection was required for correct diagnosis.
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Affiliation(s)
- Ayako Watanabe
- Department of Surgery, Japanese Red Cross Kobe Hospital, Kobe 651-0073,
| | - Yoshihiko Kadowaki
- Department of Surgery, Japanese Red Cross Kobe Hospital, Kobe 651-0073, Japan
| | - Kenji Hattori
- Department of Surgery, Japanese Red Cross Kobe Hospital, Kobe 651-0073, Japan
| | - Mika Ohmori
- Department of Radiology, Japanese Red Cross Kobe Hospital, Kobe 651-0073, Japan
| | - Hiroyuki Tsukayama
- Department of Surgery, Japanese Red Cross Kobe Hospital, Kobe 651-0073, Japan
| | - Nobuhito Kubota
- Department of Surgery, Japanese Red Cross Kobe Hospital, Kobe 651-0073, Japan
| | - Tatsuo Okumoto
- Department of Surgery, Japanese Red Cross Kobe Hospital, Kobe 651-0073, Japan
| | - Nobuhiro Ishido
- Department of Surgery, Japanese Red Cross Kobe Hospital, Kobe 651-0073, Japan
| | - Takeshi Okino
- Department of Pathology, Japanese Red Cross Kobe Hospital, Kobe 651-0073, Japan
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Abstract
The aim of the current study was to enhance the awareness of phlebosclerotic colitis (PC) through our clinical experience.A retrospective review of 25 patients who were diagnosed as PC in our 2 affiliated hospitals from January 2013 to October 2017 was conducted.The patients were found at a mean age of 63.5 years, range 47 to 87years. The majority of patients were male (23 cases). Only 4 patients (16%, 4/25) had the history about long-term use of Chinese herbs and medical liquor. The most common symptoms were abdominal pain (40%) and intestinal obstruction (16%), followed by diarrhea (12%), and gastrointestinal bleeding (12%), etc. Three cases (12%) had no symptoms. The varying degrees of calcifications along the colon and mesenteric venous were found in all of their computed tomography (CT) images. The lesions mainly located in transverse and ascending colon (60%, 15/25). The terminal ileum, the whole colon and rectum involvement were also been found. Fourteen patients had the examination of colonoscopy which all presented characteristic dark purple-colored endoscopic findings. Conservative treatment with close follow-up was preferred in our group. Three cases had the surgery of colectomy due to the repeatedly intestinal obstruction, perforation.The PC was a very rare but characteristic entity with unclear etiopathogenesis. Examination of abdomen CT and colonoscopy could help you to make clinical diagnosis.
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Affiliation(s)
- Wenguo Chen
- Department of Gastroenterology, The First Affiliated Hospital
| | - Huatuo Zhu
- Department of Gastroenterology, The First Affiliated Hospital
| | - Hongtan Chen
- Department of Gastroenterology, The First Affiliated Hospital
| | - Guodong Shan
- Department of Gastroenterology, The First Affiliated Hospital
| | - Guoqiang Xu
- Department of Gastroenterology, The First Affiliated Hospital
| | - Lihua Chen
- Department of Gastroenterology, The First Affiliated Hospital
| | - Fei Dong
- Department of Radiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Hozumi H, Hokari R, Shimizu M, Maruta K, Narimatsu K, Sato H, Sato S, Ueda T, Higashiyama M, Watanabe C, Komoto S, Tomita K, Kawaguchi A, Nagao S, Miura S. Phlebosclerotic colitis that was difficult to distinguish from collagenous colitis. Dig Endosc 2014; 26:594-8. [PMID: 23902595 DOI: 10.1111/den.12151] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 06/28/2013] [Indexed: 12/29/2022]
Abstract
Phlebosclerotic colitis is a rare and recently known disease entity and its etiology is still to be elucidated. Some phlebosclerotic colitis cases are difficult to distinguish from collagenous colitis because of the similarity of pathological findings. In all Japanese case reports of phlebosclerotic colitis in which an association with the use of Chinese herbal medicine is suspected, sansisi (gardenia fruit) was included, suggesting pathogenesis of this disease. We report a case of phlebosclerotic colitis that wasdifficult to be distinguished from collagenous colitis, and an association with the use of Chinese herbal medicine was suspected as the cause of the disease.
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Affiliation(s)
- Hideaki Hozumi
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
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Fang YL, Hsu HC, Chou YH, Wu CC, Chou YY. Phlebosclerotic colitis: A case report and review of the literature. Exp Ther Med 2014; 7:583-586. [PMID: 24520249 PMCID: PMC3919902 DOI: 10.3892/etm.2014.1492] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/18/2013] [Indexed: 12/24/2022] Open
Abstract
Phlebosclerotic colitis (PC) is a rare but potentially life-threatening disease. The initial presentation may include non-specific symptoms, such as vomiting, constipation and abdominal pain; however, intestinal stenosis, gangrene and perforation may occur without appropriate management. The present report describes the case of a 56-year-old male with abdominal pain and constipation. Imaging studies revealed thread-like calcifications involving almost the entire colon, which had markedly progressed over a three-year period, and changes consistent with colonic ischemia. Angiography revealed decreased blood flow in the mesenteric veins. The patient underwent emergent subtotal colectomy, and pathological examination revealed gangrene of the colon and calcifications of the mesenteric veins. The patient’s postoperative course was uneventful. In conclusion, PC is a potentially life-threatening condition that may be diagnosed by the presence of serpentine calcifications on imaging studies. Management depends on the severity of the disease, ranging from close follow-up to prompt surgical intervention.
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Affiliation(s)
- Yue-Lin Fang
- Division of General Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, R.O.C
| | - Ho-Chi Hsu
- Division of General Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, R.O.C
| | - Yenn-Hwei Chou
- Division of General Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, R.O.C
| | - Chin-Chu Wu
- Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, R.O.C
| | - Yuh-Yu Chou
- Department of Pathology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, R.O.C
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