Isolated granulomatous phlebitis: Rare cause of ischemic necrosis of the colon

Abstract

Isolated phlebitis of the gastrointestinal tract is rare and potentially life threatening. We report on a patient who developed peritonitis, requiring emergency laparotomy, total colectomy, and ileostomy because of colon necrosis. The specimen displayed multiple ulcerations and erosions. Histology showed a predominantly lymphocytic infiltrate of small-sized and middle-sized veins in the submucosa and subserosa, associated with granulomas and foci of vein wall necrosis. Arteries were spared. No local recurrence or systemic vasculitis developed during a follow-up period of two years. Isolated granulomatous phlebitis seems to be self-limited, and its cause is unknown. Surgical resection of the diseased intestine is usually curative.

Enterocolic lymphocytic phlebitis of the right colon as a cause of massive gastrointestinal bleeding

“…The entity would range from lymphocytic, granulomatous or even necrotizing inflammation, to non‐inflammatory damage as well as myointimal hyperplasia. Similar cases have been reported later, published as lymphocytic phlebitis, intramural mesenteric venulitis, giant cell phlebitis or granulomatous phlebitis [12–16]. Finally, Saraga and Bouzourenne [2] described three new patients and rewieving the literature, concluded that all the findings were morphological variants of the same entity, under the generic term of enterocolic phlebitis.…”

Enterocolic Lymphocytic Phlebitis: Statistical Analysis of Histology Features in Viable and Ischemic Bowel

“…[3][4][5]8 The clinical presentation can be acute or subacute, with symptoms including diarrhea, crampy abdominal pain, hematochezia, blood per rectum, nausea, and vomiting. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Occasional patients have pain localized to the RLQ with nausea, vomiting, and rebound tenderness on examination, as seen in our patient, and raising suspicion for acute appendicitis. 3,6,9 Mucosal lesions in these 3 patients included a polypoid ileocecal valve with intussusception, a polypoid cecal mass, and confluent cecal ulcers.…”

“…1,12 Variations on the general theme include granulomatous and necrotizing phlebitis. 5,8,11,13 Thrombi of varying age are an accepted complication of phlebitis, whereas myointimal hyperplasia, with a greater propensity for the left colon, may be completely unrelated. 2,5,11,13,14 Enterocolic lymphocytic phlebitis morphology may evolve throughout its disease course, and certain features may correlate with symptomatic ischemia.…”

“…5,6 Enterocolic lymphocytic phlebitis is usually an artery-sparing vasculitis limited to the gastrointestinal tract, with obvious phlebitis in viable and ischemic portions of resected bowel. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Because ELP may have a variety of clinical prodromes, phlebitis morphologies, and disease resolutions, we sought to statistically analyze the histology features within viable and ischemic segments of resected bowel. Are some phlebitis morphologies associated specifically with subclinical versus ischemic manifestations?…”

Mesenteric Venulitis in a 71-Year-Old Man after Acute Appendicitis

“…16 Infrequent, or absent altogether, are macrophages and polymorphonuclear leukocytes. 14,17 The presence of cytotoxic T cells, and absence of neutrophils, implicates the lymphocyte as the causative agent inciting venous thrombosis. 16,18 Postulated triggers have included drug hypersensitivity.…”