Idiopathic mesenteric phlebosclerosis associated with long-term use of medical liquor: Two case reports and literature review

Abstract

A 62-year-old woman was admitted to our hospital in 2011 because of recurrent abdominal pain, nausea and constipation for six months. Computed tomography enterography (CTE) showed tortuous thread-like calcifications in the ileocolic vein and right colic vein, while colonoscopy revealed purple-blue mucosa extending from the cecum to the splenic flexure. Based on the results of these tests, the patient was diagnosed with idiopathic mesenteric phlebosclerosis (IMP). She had a history of Chinese medical liquor intake for one and a half years and her symptoms subsided after conservative treatment. In 2013, a 63-year-old male patient who presented with recurrent lower right abdominal pain, bloating, melena and diarrhea for fifteen months was admitted to our institution. Colonoscopy and CTE led to the diagnosis of IMP. He also used Chinese medical liquor for approximately 12 years. The patient underwent total colectomy and the postoperative course was uneventful. We searched for previously published reports on similar cases and analyzed the clinical data of 50 cases identified in PubMed. As some of these patients admitted use of Chinese medicines, we hypothesize that Chinese medicines may play a role in the pathogenesis of IMP.

Idiopathic mesenteric phlebosclerosis associated with herbal drugs presenting with asymptomatic fecal occult blood

“…IMP is a rare syndrome caused by chronic ischemic changes of the colon due to calcification of the veins of the colon and adjacent peritoneum . Most cases have been reported from Asian countries, especially Japan and Taiwan, which have strong associations with the use of herbal drugs . Previous studies clarified that herbal drugs containing gardenia fruit (Sanshishi) are one of the major causes of IMP.…”

“…Both the symptoms and the histological changes are reported to improve with the discontinuation of drugs containing gardenia fruit. Hence, the early detection and early discontinuation of the causative agent are important …”

Idiopathic mesenteric phlebosclerosis associated with use of Chinese herbal medicine

“…All affected patients reported in the English literature are of Asian descent. [ 6 ] Genetic factors or lifestyle factors may play a role. It may be due to long-term use of certain biochemicals and toxins, but the pathogenesis and etiology are incompletely understood.…”

Idiopathic mesenteric phlebosclerosis treated with laparoscopic subtotal colectomy: A case report

“…Idiopathic mesenteric phlebosclerosis causes various non‐specific symptoms. It is difficult to accurately diagnose IMP based only on clinical manifestations . Colonoscopy demonstrates edematous cyanotic mucosa due to venous congestion.…”

“…It is difficult to accurately diagnose IMP based only on clinical manifestations. 5 Colonoscopy demonstrates edematous cyanotic mucosa due to venous congestion. In advanced cases, multiple ulcers are seen.…”