A Seldom Recognized Cause of Intestinal Ischemia

Flaherty, Michael J.; Lie, J.T.; Haggitt, Rodger C.

doi:10.1097/00000478-199408000-00003

Cited by 98 publications

(12 citation statements)

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“…In addition to other pelvic disease and to infectious or inflammatory bowel disease, special forms of inflammatory or otherwise abnormal mucosa coexisting with diverticulosis must be considered, in order to avoid a too liberal ‘definition’ of diverticulitis, e.g. NSAID colitis, ischemia [7], diverticular colitis [8,9,10,11,12], mesenteric inflammatory veno-occlusive disease [13], coexistence of Crohn’s disease and diverticulosis or diverticulitis [14,15,16,17], and prolapsing mucosal folds in diverticular disease [18,19]. Not taking care for these differentiations makes it very difficult to compare patients, rationales and results from the literature.…”

Section: What Is Recurrent Diverticulitis?mentioning

confidence: 99%

The Gastroenterologist’s View

Lembcke¹

2012

Dig Dis

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The traditional view that recurrent episodes of diverticulitis lead to progressively complicated disease resulting in a disadvantageous course, more difficult, complicated operations and lethal outcomes did not stand the test of evidence. Only a minority of patients with acute diverticulitis will ever require surgery, and if so, this occurs during or early after the first episode. Complications and recurrence of disease after surgery are enumerable. Strong indicators favoring sigmoid colectomy are major abscess, free air, and fistula, i.e. perforating disease. This occurs predominantly at the initial presentation, frequently in younger or immunosuppressed patients. Important differential diagnoses must be considered both for initial diagnosis of diverticulitis and for recurrent episodes. Conservative management of recurrent diverticulitis is safe and best guided by gastroenterological expertise. Sophisticated ultrasound experience as a part of this competence allows detailed evaluation of the local status and the best evidence in the literature for diagnosing diverticulitis is on US. In practice, however, the question of perforating diverticulitis is adequately answered by subtle CT scan. Medical therapy is usually the treatment of choice for recurrent diverticulitis. Avoidance of drugs bearing the hazard of perforation (e.g. NSAIDs) is emphasized, and smoking is strongly discouraged. A mathematical model based on published data shows that patients with recurrent diverticulitis overall (only) profit from surgery if they are hit by four episodes during the course of disease. This is where theory and reality (should) meet.

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Section: What Is Recurrent Diverticulitis?mentioning

confidence: 99%

The Gastroenterologist’s View

Lembcke¹

2012

Dig Dis

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“…Both sexes are equally affected and, even though EP appears in all ages, the disease seems to predominantly occur in patients >50 years of age (median age 60 years). MIVOD, first described by Flaherty et al in 1994 [ 7 ], has a very similar presentation to EP regarding the characteristics of patients (median age 52.5 years) and duration of symptoms. Yet, MIVOD predominantly occurs in the descending colon and the sigmoid, and affected patients more commonly suffer from nausea and vomiting.…”

Section: Resultsmentioning

confidence: 99%

“…The histological features of MIVOD with predominantly lymphocytic phlebitis of the bowel wall and mesentery accompanied by venous thrombi of different ages and necrotic mucosal lesions [ 7 ] are barely distinguishable from those of EP.…”

Section: Resultsmentioning

confidence: 99%

Enterocolic phlebitis: a rare cause of bowel ischemia and review of the literature

Bowee

Matter

Dawson

et al. 2022

Gastroenterology Report

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Enterocolic phlebitis (EP) is a rare cause of bowel ischemia due to isolated venulitis of the bowel wall and mesentery without arterial involvement. EP is often misdiagnosed as inflammatory bowel disease, carcinoma, or diverticulitis due to non-specific symptoms as well as non-specific clinical and radiological findings. While unresponsive to pharmacotherapy, surgical resection of the affected bowel appears to be the only successful therapy with a very low recurrence rate. Etiology of EP remains unknown. We report a case of EP with rare presentation in the left hemicolon and unusual histological findings emphasizing the heterogeneity of this cause of enterocolic ischemia. The review and comparison of the three entities—EP, mesenteric inflammatory veno-occlusive disease (MIVOD), and idiopathic myointimal hyperplasia of mesenteric veins (IMHMV), all describing patterns of bowel ischemia due to isolated pathology of mesenteric veins—reveal that the current terminology is unclear. EP and MIVOD are very similar and may be considered the same disease. IMHMV, though, differs in localization, symptom duration, and histological findings but also shares features with EP and MIVOD. Further studies and harmonized terminology are inevitable for better understanding of the disease, prevention of unnecessary pharmacotherapy, and reduction in time to diagnosis.

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“…6,10,15,16,18,21 However, they often present with aggressive progression over weeks, diffuse enterocolic involvement, and characteristic lymphocytic infiltration. 6,23 Possibly, in this case, the ileum and the proximal colonic segment were affected due to obliteration of the distal SMV, while the descending colon was preserved because it was near the patent proximal SMV, to which collateral draining vessels could easily be formed.…”

Section: E715mentioning

confidence: 92%

Idiopathic Myointimal Hyperplasia of the Mesenteric Veins Is a Peculiar Venous Ischemia That May Be Diagnosed Before Surgery

Kim

Park

Yoon

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Idiopathic myointimal hyperplasia of the mesenteric veins is a segmental ischemia associated with noninflammatory hyperplasia of the intimal smooth muscle of the mesenteric veins. Owing to its rarity, timely diagnosis is often difficult. OBJECTIVE:The goal of this study was to improve clinical practice in terms of the diagnosis of idiopathic myointimal hyperplasia of the mesenteric veins. DESIGN:This was a retrospective observational study. SETTINGS:This study was conducted in a single institution with case collection from clinical archives.PATIENTS: Data from 12 cases of idiopathic myointimal hyperplasia of the mesenteric veins were retrieved from 2006-2020. Most patients were elderly men, with a maleto-female ratio of 10:1. MAIN OUTCOME MEASURES:Clinical, endoscopic, radiologic, and pathologic characteristics of idiopathic myointimal hyperplasia of the mesenteric veins served as outcome measures. RESULTS:Radiologically, marked segmental mural thickening and poor enhancement involved the sigmoid colon and rectum in most cases, with extension to the descending colon in some cases. Typical cases showed obliteration of the inferior mesenteric veins and collateral vessels. Colonoscopic findings were reminiscent of ischemia or ulcerative colitis, but sharp demarcation from the uninvolved segment was the most distinguishing feature. Surgically resected specimens showed marked segmental mural thickening, edema, and mucosal discoloration grossly. Microscopically, thick-walled, tortuous veins were observed mainly in the submucosa and subserosa, and the submucosa was markedly thickened in all cases. The subserosal large veins showed myointimal hyperplasia, and pericolic fat necrosis was invariably observed. The most useful histologic finding in biopsy material was tortuous, arteriolized mucosal capillaries with occasional fibrinoid necrosis. LIMITATIONS:This study was limited by its small number of cases and selection bias; there was also no prospective external validation.CONCLUSIONS: Radiologic and pathologic features of idiopathic myointimal hyperplasia of the mesenteric veins are distinct from those of ulcerative colitis or nonspecific ischemic colitis. Careful interpretation of endoscopic and radiologic images and generous biopsies with interpretation by experienced pathologists might lead to an early diagnosis and prevent unnecessary medical treatment. See

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A Seldom Recognized Cause of Intestinal Ischemia

Cited by 98 publications

References 0 publications

The Gastroenterologist’s View

The Gastroenterologist’s View

Enterocolic phlebitis: a rare cause of bowel ischemia and review of the literature

Idiopathic Myointimal Hyperplasia of the Mesenteric Veins Is a Peculiar Venous Ischemia That May Be Diagnosed Before Surgery

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