Intramural mesenteric venulitis

Abstract

Venous damage is an uncommon cause of intestinal ischaemia. We report on a 44-year-old woman who presented signs and symptoms of acute intestinal ischaemia requiring surgical treatment. Histological examination of the resected right colon showed features of an intramural lymphocytic venulitis with no other demonstrable causes of ischaemic injury of the bowel. Extramural mesenteric veins appeared dilated and congested, without evidence of thrombotic occlusion or of inflammatory involvement. The patient, who was not taking any long-term medication and had no clinical evidence of collagen-vascular disease, promptly recovered after surgery. Follow-up for 7 months with no recurrences suggested a self-limited or indolent process. We propose the name 'intramural mesenteric venulitis' for this condition and believe that it could represent one extreme (the microscopic variant or intramural phase) of the spectrum comprising entero-colic phlebitis and mesenteric inflammatory veno-occlusive disease. The immunohistochemical evidence of a marked preponderance of T phenotype in the perivenular lymphocytes suggests lymphocyte-mediated vascular damage as the pathogenesis of the lesion.

Mesenteric Venulitis: A Rare Etiology of Hematochezia and “Colitis” with Distinctive Colon Pathology

“…This entity differs from mesenteric inflammatory veno-occlusive disease in its histological features, even though they have a similar clinical presentation. Fluharty et al [1] described seven patients with veno-occlusive inflammatory disease of the mesenteric veins and venules. Three of these patients had myointimal hyperplasia of the venules, with lymphocytic infiltration.…”

“…Mesenteric inflammatory veno-occlusive disease has been reported as a rare cause of intestinal ischemia and GI bleeding. The ischemia mainly affects the right colon and terminal ileum [1]. It may present as a precursor of idiopathic myointimal hyperplasia of the mesenteric veins [1].…”

“…The ischemia mainly affects the right colon and terminal ileum [1]. It may present as a precursor of idiopathic myointimal hyperplasia of the mesenteric veins [1]. This particular entity has also been interpreted as or termed intramural mesenteric venulitis [2].…”

Cryptogenic, Multifocal, Ulcerous, and Stenosing Enteritis as a Manifestation of Enterocolic Venopathy

“…Primary gastrointestinal vasculitis involving mesenteric or enterocolic veins is extremely uncommon (2–4,11–17). Nonetheless, a spectrum of primary intestinal venular pathology has been described.…”

“…Clinical remission can be achieved with systemic corticosteroids and/or surgical resection, although relapse has been reported (1,6). Primary gastrointestinal vasculitis involving mesenteric or enterocolic veins is extremely uncommon (2)(3)(4)(11)(12)(13)(14)(15)(16)(17). Nonetheless, a spectrum of primary intestinal venular pathology has been described.…”