Idiopathic myointimal hyperplasia of the mesenteric veins affecting the small intestine alone: A case report and review of literature

Table 1 Clinical characteristics of all reported cases of idiopathic myointimal hyperplasia of the mesenteric veins to date

Case	Ref.	Age (year)/sex	Symptoms	Affected site	Clinical impression	Indication for surgery	Time to surgery	Follow-up
1	Current case	50/F	Abdominal pain, abdominal distension	Terminal ileum	CD	Bowel obstruction	6 years (this operation)/1 year (the first operation)	1 month
2	Li et al[7]	64/M	Abdominal pain, abdominal distension, weight loss	Terminal ileum	IBD	Bowel obstruction	6 months	1 year
3	Yamada et al[24]	81/F	Abdominal pain, nausea and vomiting	Terminal ileum	Adhesive intestinal obstruction	Bowel obstruction	1 year	32 months
4	Guadagno et al[47]	59/F	Abdominal pain, diarrhea, weight loss	Ileum	CD	Bowel obstruction	6 months	3 months
5	Laskaratos et al[25]	62/F	Abdominal pain, diarrhea	Terminal ileum	IBD	Perforation	-	-
6	Lanitis et al[37]	81/M	Abdominal pain, abdominal distension, constipation, weight loss, anorexia, bilateral lower limb edema	Terminal ileum	-	Appendiceal mucocoele and pseudomyxoma peritonei	6 months	-
7	Bryant[30]	42/F	Chest pain, seizures	Jejunum	-	-	-	-
8	Louie et al[27]	57/F	Abdominal pain, nausea	Jejunum/ileum	-	CT scan showed bowel ischemia	-	24 months
9	Martin et al[43]	63/M	Diarrhea, hematochezia, weight loss, fever	Rectum - DC	IC	Persisting symptoms	3.75 months	-
10-13	Lincango et al[42]	Mean 55 (range 45-61)/4 M	Abdominal pain (n = 3), diarrhea (n = 1), fever (n = 1), tenesmus (n = 2), rectal pain (n = 1), constipation and diarrhea alternated (n = 2), back pain (n = 1), abdominal distention (n = 1), weight loss (n = 1), nausea (n = 1)	Rectum - DC (n = 1), SC (n = 1), SC - DC (n = 1), RS (n = 1)	UC (n = 2), IC (n = 1), UC/IC (n = 1)	Medically refractory (n = 3), bowel obstruction (n = 1)	> 10 days (n = 1)	Mean 69 months (range 12-144 months)
14	Al Ansari et al[18]	63/M	Abdominal pain, diarrhea	SC - DC	Entamoeba histolytica colitis	Persisting symptoms	41 days	5 years
15-26	Kim et al[19]	Mean 66 (range 58-77)/11 M and 1F	Abdominal pain (n = 10), diarrhea (n = 9), constipation (n = 3), mucoid stools (n = 3), perianal pain (n = 1), weight loss (n = 1), fever (n = 2), tenesmus (n = 1), abdominal distension (n = 1)	RS (n = 9), rectum - DC (n = 2), TC - terminal ileum (n = 1)	IC (n = 4); UC (n = 1), nonspecific colitis (n = 1), CMV colitis (n = 1), idiopathic phlebosclero colitis (n = 1), IMHMN (n = 3)	-	Mean 3 months (range 1-8 months)	Mean 29 months (range 2-125 months)
27	Chudy-Onwugaje et al[48]	54/M	Abdominal pain, diarrhea, weight loss	TC	CMV colitis	Persisting symptoms	4 months	-
28	Zhou et al[44]	67/M	Abdominal pain, diarrhea, hematochezia, weight loss	Rectum - DC	UC	Persisting symptoms	6.25 months	-
29	Han et al[31]	74/M	Abdominal pain, diarrhea, hematochezia, weight loss	Rectum - TC	IMHMV	Persisting symptoms, IMHMV was suspected	1 year	5.5 months
30	Kelly et al[38]	53/M	Abdominal pain, hematochezia, weight loss, tenesmus	Rectum - DC	UC/IMHMV	Persisting symptoms	3 months	3 months
31	Noujaim et al[49]	66/M	Abdominal pain, diarrhea, hematochezia, weight loss, fever, night sweats	Rectum - DC	IBD/IMHMV/C. difficile infection	Acute abdomen	> 2 months	Died on postoperative day 4
32	Yun et al[20]	64/M	Abdominal pain, diarrhea, hematochezia	Rectum - TC	Non-thrombotic veno-occlusive disease, such as IMHMV	IMHMV was suspected	2 years	6 months
33	Almumtin et al[46]	55/M	Abdominal pain, hematochezia, weight loss, constipation, fever	Rectum - TC	IBD	Perforation	1 year	-
34	Shah et al[12]	24/F	Abdominal pain, hematochezia	Rectum - DC	IC	Abdominal pain/perforation	> 1 month	-
35	Kawasaki et al[17]	71/M	Abdominal pain, constipation	RS	IMHMV	IMHMV was suspected	4 months	8 months
36	Wong et al[21]	72/M	Abdominal pain, diarrhea, hematochezia	Rectum - DC	IC/IMHMV	Acutely worsening abdominal pain with peritoneal signs	Several days	-
37	Dillione et al[50]	47/M	Abdominal pain, hematochezia	RS	Ischemic proctitis	Persisting symptoms	Several weeks	-
38	Wangensteen et al[28]	62/F	Abdominal pain, diarrhea, hematochezia	Rectum - DC	UC (initial)/IMHMV	Persisting symptoms, IMHMV was suspected	> 3 months	1.5 years
39-48	Yantiss et al[35]	Mean 68 (range 25-83)/9 M and 1F	Abdominal pain (n = 6), diarrhea (n = 10), hematochezia (n = 9), weight loss (n = 2), Palpable mass (n = 1)	Rectum - DC (n = 7), SC (n = 1), SC - DC (n = 1)	IC/IBD (n = 1), IBD (n = 7), IC (n = 2)	Perforation (n = 5), obstruction and refractory colitic symptoms	-	-
49	AbiMansour et al[40]	59/M	Abdominal pain, diarrhea, urgency	SC	Diverticulitis	Persisting symptoms	1 year	-
50	Patel et al[51]	65/M	Abdominal pain, rectal urgency, tenesmus	Rectum - DC	CD/IMHMV	Perforation	> 1.5 months	-
51	Morimura et al[11]	44/M	Abdominal pain, constipation, fever	Rectum - TC	IBD/Eosinophilic enteritis	Bowel ischemia and necrosis with peritonitis	> 1 month	1 year
52	Xie et al[52]	21/F	Abdominal pain, diarrhea, hematochezia, fever, tenesmus	RS	Acute IBD	Massive hematochezia, shock	> 20 days	2 years
53	Cauchois et al[53]	48/M	Abdominal pain, diarrhea, hematochezia, fever, weight loss	RS	UC	Persistent symptoms	5 months	-
54	Costa et al[33]	47/M	Abdominal pain, diarrhea, hematochezia, fever, tenesmus, proctalgia, fecal incontinence	RS	IBD/IC	Persistent symptoms	9 months	-
55-62	Anderson et al[34]	Median 62.5 (range 22-75)/6 M and 2F	Abdominal pain (n = 7), diarrhea (n = 5), hematochezia (n = 4)	SC (n = 6)	IBD (n = 3)	-	-	-
63	Mohtashami et al[45]	61/M	Abdominal pain, diarrhea, hematochezia, abdominal distension	Rectum - DC	CD	Perforation	3 weeks	-
64	Gonai et al[54]	68/M	Abdominal distension, constipation, mucoid stools	SC - DC	Chronic venous ischemic disease	Persistent symptoms	-	-
65	Sahara et al[1]	76/M	Abdominal pain, diarrhea	RS	UC/IC	Severe pain	13 months	3 months
66	García-Castellanos et al[32]	32/F	Abdominal pain, diarrhea, hematochezia	Rectum - DC	Primary pneumatosis intestinalis, IC	Persistent rectal bleeding, severe pain	3 months	24 months
67	Feo et al[55]	75/F	Abdominal pain, diarrhea, hematochezia, weight loss, tenesmus	RS	IC	Persistent symptoms	6 months	-
68	Bhatt et al[29]	82/M	Abdominal distension, diarrhea, erratic bowel movements, urgency, mucoid stools, weight loss	Rectum - DC	IC	Persistent symptoms	3 months	> 1 year
69	Bhatt et al[29]	59/M	Diarrhea, tenesmus	RS	Diverticulitis (initial)/IMHMV	Persistent symptoms/ MRI suggested IMHMV	-	> 1 year
70	Abbott et al[56]	58/M	Abdominal pain, diarrhea, hematochezia	Rectum - DC	Entameba histolytica infection/IBD	Persistent symptoms	Several weeks	-
71-74	Genta and Haggitt[3]	Mean 40 (range 25-67)/4 M	Abdominal pain (n = 4), hematochezia (n = 4), constipation and diarrhea alternated (n = 3)	SC (n = 1), Rectum - DC (n = 1), RS (n = 2)	UC (n = 2), CD (n = 1), Stricture (n = 1)	Bowel obstruction (n = 1), toxic megacolon (n = 1), abdominal pain and hematochezia (n = 2)	Mean 3 months (range 1-6 months)	Mean 3.5 years (range 1-7 years)
75	Kao et al[9]	38/M	Abdominal pain, rectalgia, constipation, hematochezia, mucoid stools, weight loss	RS	Idiopathic chronic IBD	Perforation	5 months	18 months
76	Yang et al[22]	44/M	Abdominal pain, diarrhea, hematochezia	RS	UC/IC	Persistent symptoms	2 months	-
77	Savoie et al[57]	22/M	Abdominal pain, diarrhea, hematochezia, tenesmus	RS	UC	Persistent symptoms	> 2 weeks	10 months
78	Abu-Alfa et al[4]	58/M	Abdominal pain, diarrhea, hematochezia	SC	IBD/IC	Persistent bleeding, severe pain	1 year	-
79	Chiang et al[39]	60/M	Abdominal pain, diarrhea, hematochezia, weight loss	RS	UC	Persistent symptoms	2 months	4 months
80	Coombs et al[23]	33/M	Abdominal pain, constipation, hematochezia	RS	IC	Persistent rectal bleeding and abdominal pain	4 weeks	-
81	Uwah et al[36]	37/M	Abdominal pain, constipation and diarrhea alternated, hematochezia	Rectum - DC	IBD/IC	Persistent symptoms/stricture	> 2 months	-
82	Uwah et al[36]	49/M	Abdominal pain, diarrhea, hematochezia	Rectum - DC	Colitis of unknown etiology	Persistent symptoms	Several months	-
83	López et al[58]	37/F	Abdominal pain, diarrhea	Rectum - terminal ileum	CD	Acute abdomen	7 months	Died
84	Song et al[26]	59/M	Abdominal pain, abdominal distension, constipation and diarrhea alternated, Incontinence	Rectum - terminal ileum	CD	Persistent symptoms	-	-
85	Louie et al[27]	45/M	Lower gastrointestinal bleeding	RS	UC	-	-	-

C. difficile: Clostridioides difficile; CD: Crohn’s disease; CMV: Cytomegalovirus; DC: Descending colon; F: Female; IBD: Inflammatory bowel disease; IC: Ischemic colitis; IMHMV: Idiopathic myointimal hyperplasia of the mesenteric vein; M: Male; MRI: Magnetic resonance imaging; RS: Rectosigmoid colon; SC: Sigmoid colon; TC: Transverse colon; UC: Ulcerative colitis.

Table 2 Comparison between small intestinal and colonic idiopathic myointimal hyperplasia of the mesenteric veins

Clinical characteristics	Colonic IMHMV (n = 77)		Small intestinal IMHMV (n = 8)
Mean age, years (range)	57 (21-82)		62 (42-81)
Sex
M	67		2
F	10		6
Symptoms and signs	Abdominal pain	64	Abdominal pain	7
	Diarrhea	51	Diarrhea	2
	Hematochezia	49
	Constipation	8	Constipation	1
	Tenesmus	10
	Weight loss	16	Weight loss	3
	Fever	10	Nausea and vomiting	2
	Constipation and diarrhea alternated	8	Anorexia	1
	Abdominal distension	5	Abdominal distension	3
	Mucoid stools	9	Chest pain	1
	Rectal urgency	3	Seizures	1
	Fecal incontinence	2	Bilateral lower limb edema	1
	Perianal pain	2
Preoperative clinical impression	IBD	33	IBD	4
	IC	14
	IBD/IC	7
	IMHMV	9	Adhesive intestinal obstruction	1
Endoscopic findings	Congested, edematous, friable mucosa	58	Congested, edematous, friable mucosa	2
	Ulcer	44	Ulcer	3
	Erythema	34
	Intestinal stenosis	19	Intestinal stenosis	1
	Pseudopolyps	5
Affected site	Rectum - DC	24	Terminal ileum	5
	Rectum - TC	4	Ileum	1
	RS	26	Jejunum	1
	SC	11	Jejunum/ileum	1
	SC - DC	4
	DC	1
	TC	1
	Rectum - terminal ileum	2
	TC - terminal ileum	1
Time to surgery (range); follow-up period (range), months	4.4 (0.25, 24); 28.5 (2, 144)		8.4 (6, 12); 14.4 (1, 32)
Indication for surgery	Clinical symptoms continued to worsen and medical treatment was ineffective	23	Appendiceal mucocoele and pseudomyxoma peritonei	1
	IMHMV was suspected and surgery was performed to confirm the diagnosis	7	CT scan showed bowel ischemia	1
	Acute abdomen	3
	Massive hematochezia and medical treatment was ineffective	6
	Bowel obstruction	2	Bowel obstruction	4
	Perforation	9	Perforation	1

C. difficile: Clostridioides difficile; CT: Computed tomography; DC: Descending colon; F: Female; IBD: Inflammatory bowel disease; IC: Ischemic colitis; IMHMV: Idiopathic myointimal hyperplasia of the mesenteric vein; M: Male; MRI: Magnetic resonance imaging; RS: Rectosigmoid colon; SC: Sigmoid colon; TC: Transverse colon.