A rare cause of ischemic proctosigmoiditis: idiopathic myointimal hyperplasia of mesenteric veins

Chiang, Chuan-Chi; Lee, C.-L.; Huang, C.-S.; Huang, Shih‐Hung; Wu, Ching Herng

doi:10.1055/s-0031-1291529

Cited by 18 publications

(18 citation statements)

References 4 publications

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“…2 Myointimal hyperplasia of the mesenteric veins occurs (best identified with elastin stain on histopathology) with near total occlusion of the venous lumen and without any associated inflammatory infiltrate or arterial involvement. 3 After colectomy, our patient's abdominal symptoms resolved and follow-up colonoscopy at 6 months did not reveal recurrence of IMHMV, at which time, patient underwent take-down of his colostomy. In the year after colostomy take-down, the patient showed no clinical or endoscopic signs of colitis while off of all medical therapies.…”

Section: Answer To Image 1 (Page 1075): Idiopathic Myointimal Hyperplmentioning

confidence: 63%

A Challenging Case of Colitis in a Young Man

2016

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Question: A 25year-old obese, African American man with no significant past medical history except for recent weight loss of 70 pounds presented for evaluation of bloody diarrhea and abdominal pain. The patient described sharp, left lower quadrant pain that progressively worsened over a 6-month period, along with loose bowel movements containing blood and mucous that occurred 20 to 40 times daily. A computed tomography scan of the abdomen revealed colonic wall thickening from the descending colon to the rectum. A flexible sigmoidoscopy demonstrated an area of congested, friable, dusky mucosa with overlying whitish exudate in the rectosigmoid colon ( Figure A). Endoscopic biopsies were most consistent with ischemic colitis. A comprehensive work up for infectious colitis (including Clostridium difficile, stool culture, ova and parasites, cytomegalovirus, syphilis, herpes simplex virus, gonorrhea, and chlamydia), hypercoagulability, vasculitis, and illicit drugs was negative. A computed tomography angiogram of the abdomen/pelvis showed widely patent mesenteric vasculature and diffuse mucosal thickening of the sigmoid colon with inflammatory stranding surrounding the mesentery of the sigmoid colon and rectum. There was no portal venous gas or pneumatosis coli.Owing to ongoing abdominal pain and profuse bloody diarrhea despite optimal resuscitative measures, the patient underwent a laparoscopic-assisted sigmoid resection with end colostomy and a Hartmann procedure, leaving a short rectal stump ( Figure B), which completely abolished his symptoms.What is the diagnosis? Look on page 1076 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

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Section: Answer To Image 1 (Page 1075): Idiopathic Myointimal Hyperplmentioning

confidence: 63%

A Challenging Case of Colitis in a Young Man

2016

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“…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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“…Patients typically present with weight loss, abdominal pain, and bloody diarrhea [12, 13]. Colonoscopy may show a friable mucosa with ulcerations and erythematous and edematous changes [14–16].…”

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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A rare cause of ischemic proctosigmoiditis: idiopathic myointimal hyperplasia of mesenteric veins

Cited by 18 publications

References 4 publications

A Challenging Case of Colitis in a Young Man

A Challenging Case of Colitis in a Young Man

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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