Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2024; 12(10): 1810-1816
Published online Apr 6, 2024. doi: 10.12998/wjcc.v12.i10.1810
Idiopathic mesenteric phlebosclerosis missed by a radiologist at initial diagnosis: A case report
Min Wang, Yu-Xia Wan, Jin-Wen Liao, Fei Xiong
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
Co-first authors: Min Wang and Yu-Xia Wan.
Author contributions: Wang M, Wan YX, Liao JW, and Xiong F designed the research study; Wang M and Wan YX drafted the manuscript and provided the images; Liao JW and Xiong F performed the review; Wang M and Wan YX contributed equally to this work as co-first authors; all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report.
Conflict-of-interest statement: The authors declare no potential conflicts of interest concerning the research, authorship, and/or publication of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei Xiong, MD, Attending Doctor, Department of Gastroenterology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 18 Huanhua North Road, Chengdu 610000, Sichuan Province, China. feiji19841984@gmail.com
Received: November 20, 2023
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
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.

Keywords: Idiopathic mesenteric phlebosclerosis, Computed tomography, Colonoscopy, Chinese patent medicines, Fructus gardeniae, Case report

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.