Idiopathic myointimal hyperplasia of mesenteric veins: Rare case of ischemic colitis mimicking inflammatory bowel disease

Sahara, Kota; Yamada, Ryuzo; Fujiwara, Takashi; Koizumi, Koichi; Horiguchi, Shinichiro; Hishima, Tsunekazu; Yamaguchi, Tatsuro

doi:10.1111/den.12470

Cited by 22 publications

(26 citation statements)

References 9 publications

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“…Colonic stenoses developed after antibiotic-related cololitis caused by Clostridium difficile progressively, which was confirmed by two barium exams. Sahara K and Kawaratani H reported that it is adult inflammatory bowel disease that causes colonic stenosis, and stool culture suggests Clostridium difficile [ 35 , 36 ], but in our case the underlying disease wasn’t present. This patient did have a history of intestinal infection of Clostridium difficile prior to onset of symptoms though.…”

Section: Discussionmentioning

confidence: 56%

Infant progressive colonic stenosis caused by antibiotic-related Clostridium difficile colitis – a case report and literature review

Xie

Xiang

et al. 2018

BMC Pediatr

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BackgroundColonic stenosis is a rare cause of pediatric intestinal obstruction. The root cause underlying colonic stenosis is unclear and there is no fixed operation.Case presentationWe reported on a male infant with progressive colonic stenosis caused by antibiotic-related colitis. The infant was admitted to our hospital with pneumonia but developed progressive abdominal distension and diarrhea following antibiotic treatment with meropenem. Initial testing of stool culture showed a Clostridium difficile infection. Additional testing with barium enema imaging showed stenosis at the junction of the sigmoid and descending colon at first and another stenosis occurred at the right half of the transverse colon 3 weeks later. Staged surgical treatment was performed with primary resections of the two parts suffering stenosis, ileostomy, and secondary intestinal anastomosis. A pathological exam then confirmed the diagnosis of colonic stenosis and the patient had an uneventful recovery and has been recovering well as evidenced by the 1-year follow-up.ConclusionsBased on a review of the literature and our case report, we found that progressive colonic stenosis caused by colitis due to antibiotic-related Clostridium difficile infection is rare in infants. Infants with colitis and repeated abdominal distention, vomiting, and constipation should be treated with the utmost caution and screened. Despite this, clinical manifestations depended on the severity of the stenosis. Barium enema, colonoscopy, laprascopy or laparotomy and colonic biopsy are helpful for diagnosis and differential diagnosis. While both one-stage and multiple-stage operations are feasible, a staged operation should be used for multiple colonic stenoses.

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Section: Discussionmentioning

confidence: 56%

Infant progressive colonic stenosis caused by antibiotic-related Clostridium difficile colitis – a case report and literature review

Xie

Xiang

et al. 2018

BMC Pediatr

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“…Of the 34 cases of IMHMV that occurred in men, usually in late middle age (median age at diagnosis 62 years) . Many of these patients, including our patient, have cardiovascular risk factors or disease . The non‐specific presenting symptoms include diarrhea, usually bloody; lower abdominal pain; and weight loss, resulting in the frequent misdiagnosis of IBD.…”

Section: Discussionmentioning

confidence: 85%

“…The etiology of this nonthrombotic occlusion of mesenteric veins is poorly understood. First described by Genta and Haggitt in 1991, 33 reported cases of IMHMV have now been reported (Table ), and it is likely there are many more misdiagnosed or not reported.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic myointimal hyperplasia of the mesenteric veins: Case report and review of the literature

et al. 2019

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In 1991, Genta and Haggitt described four patients with segmental ischemic colitis caused by idiopathic myointimal hyperplasia in the small mesenteric veins (IMHMV). There are now 33 published cases of IMHMV in the literature; however, this condition is still sufficiently rare that it poses a diagnostic challenge to pathologists and clinicians and is often clinically or histologically confused with inflammatory bowel disease (IBD) or ischemic colitis. IMHMV is characterized by intimal smooth muscle hyperplasia resulting in thickened small and medium‐sized mesenteric veins (with arterial sparing). Clinically, it presents with symptoms that mimic IBD, such as bloody diarrhea, abdominal pain, and weight loss. Surgical resection appears to be curative. The present case describes a 63‐year‐old Vietnamese man with cardiovascular risk factors who was diagnosed with IMHMV after many months of severe symptoms. A review of the current literature follows the case report.

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“…Additionally, an elastin stain can be used to highlight the elastic laminae present in arteries and absent in the affected veins, an important diagnostic clue [12]. The degree of luminal occlusion is variable but often results in an ischemic pattern of injury such as ulceration, superficial withering of crypts, edema, congestion, and, later on in the disease process, hyalinization and fibrosis of the lamina propria and/or submucosa [3, 6, 11, 17]. Notably absent on histology are chronic inflammatory changes.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Myointimal Hyperplasia of Mesenteric Veins of the Ileum and Colon in a Patient with Crohn’s Disease: A Case Report and Brief Review of the Literature

Song

Shroff

2017

Case Reports in Pathology

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Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare disease characterized by intimal smooth muscle proliferation, leading to the thickening of small to medium-sized mesenteric veins. This vascular disease mimics inflammatory bowel disease (IBD) clinically and endoscopically, while showing ischemic mucosal changes without the classic features of IBD on biopsy. Given the mixed picture, this entity is frequently misdiagnosed. Surgical resection of the diseased bowel segment reveals the true etiology of the pathology and is curative. We describe a case of a 59-year-old man with a long-standing history of Crohn's disease refractory to medical therapy and status after multiple small bowel resections. The patient underwent a subtotal abdominal colectomy with pathology showing dense, indurated mesenteric adipose tissue, significant muscularis propria hypertrophy, and myointimal hyperplasia of the mesenteric veins in a peri-ileal and pericolic distribution, as confirmed by elastin stain. No evidence of mucosal ischemic changes or findings of chronicity or acuity were seen. IMHMV, a rare disease with a mixed presentation, poses a significant diagnostic challenge to clinicians and pathologists.

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Idiopathic myointimal hyperplasia of mesenteric veins: Rare case of ischemic colitis mimicking inflammatory bowel disease

Cited by 22 publications

References 9 publications

Infant progressive colonic stenosis caused by antibiotic-related Clostridium difficile colitis – a case report and literature review

Infant progressive colonic stenosis caused by antibiotic-related Clostridium difficile colitis – a case report and literature review

Idiopathic myointimal hyperplasia of the mesenteric veins: Case report and review of the literature

Idiopathic Myointimal Hyperplasia of Mesenteric Veins of the Ileum and Colon in a Patient with Crohn’s Disease: A Case Report and Brief Review of the Literature

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