Idiopathic Mesenteric Phlebosclerosis: A Single-Institute Experience in Taiwan

Abstract

Background: Idiopathic mesenteric phlebosclerosis is a rare condition with unclear pathogenesis. This study aimed to investigate the clinical features, diagnostic modalities, treatments, and outcomes of idiopathic mesenteric phlebosclerosis patients in Taiwan. Methods: Idiopathic mesenteric phlebosclerosis patients diagnosed by the typical characteristic of tree-like mesenteric venous calcifications on plain abdominal radiography or computed tomography between January 1992 and July 2021 were retrospectively analyzed. Results : Totally, 36 idiopathic mesenteric phlebosclerosis patients were enrolled (50% females; mean age, 61.6 years). Among the included patients, 26 (72.2%) and 10 (27.7%) were symptomatic and asymptomatic, respectively. Abdominal pain (61.1%) accounted for the majority of all symptoms, followed by fever, diarrhea, and bloody stools. Our results showed that 83.3% of patients had at least 1 risk factor, whereas 16.6% of patients had none. Moreover, among the included patients, 36.1%, 44.4%, 50.0%, 38.8%, and 8.3% had cardiovascular disease, chronic renal disease, cancer, chronic liver disease, and diabetes mellitus, respectively. Our findings showed 94.4% of patients were diagnosed via abdominal computed tomography and plain abdominal radiography, whereas 5.6% of patients were diagnosed via plain abdominal radiography. The ascending colon was the most commonly involved site (100%). Our findings showed that 91.6% of patients experienced good recovery after conservative treatment, except for the 3 who died of sepsis and respiratory failure. By contrast, 8.3% of idiopathic mesenteric phlebosclerosis patients underwent colectomy. The average follow-up duration was 62.5 months. Conclusions: Idiopathic mesenteric phlebosclerosis remains a rare disease in Taiwan. Plain abdominal radiography and computed tomography can be utilized for establishing a definite diagnosis. Conservative treatment is usually adequate for most patients, with surgical treatment only indicated for severe cases.

Idiopathic mesenteric phlebosclerosis missed by a radiologist at initial diagnosis: A case report

“…In the early stage, many patients with IMP (10%-27.7%) are asymptomatic[ 8 , 13 - 15 ]. However, as the disease progresses, patients may present with nonspecific symptoms such as abdominal pain, diarrhea, constipation, nausea, vomiting, abdominal distension, fever, and bloody stool[ 8 , 15 ].…”

“…In the early stage, many patients with IMP (10%-27.7%) are asymptomatic[ 8 , 13 - 15 ]. However, as the disease progresses, patients may present with nonspecific symptoms such as abdominal pain, diarrhea, constipation, nausea, vomiting, abdominal distension, fever, and bloody stool[ 8 , 15 ]. These symptoms complicate the diagnosis of IMP, necessitating the use of abdominal CT and colonoscopy for diagnostic purposes, with histopathological examination ultimately confirming the diagnosis[ 8 ].…”

Case report and literature review: Laparoscopic extended right hemicolectomy for a 55-year-old patient with idiopathic mesenteric phlebosclerosis

“…IMP is very rare in clinical practice, and the pathologic mechanism is currently unknown. It is now believed that IMP occurs primarily due to fibrotic degeneration of the venous wall leading to linear calcification along the mesenteric vessels and thickening of the colonic wall ( 3 ). We reviewed and summarized the risk factors for IMP.…”

Geniposide Causes Idiopathic Mesenteric Phlebosclerosis

“…We read with interest the manuscript by Chou et al 1 titled “Idiopathic Mesenteric Phlebosclerosis: A Single-Institute Experience in Taiwan,” which was published on February 25, 2023. Idiopathic mesenteric phlebosclerosis (IMP) is a rare form of ischemic bowel, commonly involving the proximal ascending colon, and characterized by wall thickening and serpentine calcifications of mesenteric veins.…”

“…Asian descents with long-term Chinese herbs ingestion seem to be the most susceptible etiology. Chou et al 1 reported that 36.1% of 38 patients with IMP had a history of using Chinese medicine. Which Chinese herb is the culprit is often unclear, but extracts of Gardenia jasminoides have been reported to be responsible.…”