A case of idiopathic myointimal hyperplasia of the mesenteric veins presenting with small bowel obstruction

Abstract

Background Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare ischemic bowel disease with venous occlusion resulting from the proliferation of smooth muscles in the venous intima. In most patients, the disease affects rectosigmoid colon and causes persistent abdominal pain and hematochezia, which is similar to inflammatory bowel disease (IBD). In addition, it is difficult to make a precise diagnosis of IMHMV without surgery. Case presentation An 81-year-old woman was admitted to our hospital with mild abdominal pain, nausea and vomiting. Repeated adhesive ileus was suspected due to the previous open and laparoscopic surgeries. Surgery was planned to treat small bowel obstruction. Intraoperatively no adhesive lesions were observed. However, a mass lesion was seen at the terminal ileum, which was suspected to have caused her bowel obstruction. Partial resection of the small intestine was performed. Macroscopic and histopathological examinations of the excised specimen showed circumferential ulceration with scarring, a thickened venous wall with active inflammation, and fibrotic changes that consequently produced stenosis and obstruction of the venous lumen in the subserosa. Additionally, Elastica van Gieson staining demonstrated thickening of the venous intima. The final diagnosis was IMHMV. At two years and 8 months after the operation, the patient was well without any additional medication. Conclusion IMHMV of the small intestine is rare. We described a case of IMHMV that was associated with ileus.

Idiopathic Myointimal Hyperplasia of Mesenteric Veins (IMHMV) with two spontaneous bowel perforations: A case report and literature review

“…Idiopathic Myointimal Hyperplasia of the Mesenteric Veins (IMHMV) is a poorly understood disease condition that poses diagnostic challenge to clinicians and pathologists. It is described as an ischemic bowel disease without the presence of a thrombus along with venous occlusion caused by proliferation of the smooth muscles in the tunica intima of the veins [ 1 ]. Clinically and endoscopically, IMHMV is usually misdiagnosed as an inflammatory condition of the bowel, similar to Inflammatory Bowel Disease (IBD) with same clinical features [ 2 ].…”

Idiopathic Myointimal Hyperplasia of the Mesenteric Veins: A Case Report and Scoping Review of Previously Reported Cases From Clinical Features to Treatment

“…In angiographic imaging, these collateral circulations manifest as small, aneurysm-like lesions and are considered a compensatory mechanism for mesenteric venous ischemia. These radiologic features are helpful in the diagnosis of IMHMV ( 9 , 27 , 33 ).…”

“…Compared with colonic IMHMV, small bowel IMHMVshows different features. Luminal stenosis is frequent in the small bowel, but no obvious diffuse circumferential wall thickening was observed in colonic lesions ( 33 ). One possible explanation might be the smaller luminal diameter of the ileum.…”

Capturing the often-elusive diagnosis of idiopathic myointimal hyperplasia of mesenteric veins

“…The demonstration of myointimal hyperplasia of the mesenteric veins can only be appreciated from the resection specimen, and the use of an elastin stain might be required to distinguish these vessels from mesenteric arteries. 24 The veins can be larger than their corresponding arteries, which will be spared. 25 Mucosal ulceration and signs of ischemic injury with crypt distortion, regenerative changes, and “arterialization” of capillaries will be present.…”