Published online Apr 6, 2024. doi: 10.12998/wjcc.v12.i10.1810
Peer-review started: November 20, 2023
First decision: January 17, 2024
Revised: January 31, 2024
Accepted: March 7, 2024
Article in press: March 7, 2024
Published online: April 6, 2024
Processing time: 133 Days and 17.8 Hours
Idiopathic mesenteric phlebosclerosis (IMP) is a rare type of ischemic colitis cha
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.
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.
Core Tip: 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 is based on typical clinical features and abdominal imaging. We report a case of IMP that was initially missed by the radiologist. Finally, IMP was diagnosed by a clinically experienced endoscopist.