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

Abstract

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.

Idiopathic myointimal hyperplasia of mesenteric veins: radiological evaluation using CT angiography

“…Compared with angiography, CT angiography is more useful in the diagnosis of IMHMV because it is less invasive and can show the anatomic course of the IMA and IMV, abnormal enhancement of the mesenteric venous branches in the arterial phase, and cord-like IMV in the equilibrium phase without visible enhancement. Most previously reported IMHMV cases ultimately result in surgery, 8 in contrast to ischaemic colitis, which is often treated conservatively. Patients with IMHMV should be evaluated at an early stage with CT angiography to minimize the need for surgical resection.…”