Idiopathic mesenteric phlebosclerosis associated with use of Chinese herbal medicine

Abstract

Rationale: Idiopathic mesenteric phlebosclerosis (IMP) is a rare form of ischemic colitis. It is more common in the Asian population people with Asian ancestry. Disease pathogenesis and etiology are not fully elucidated but may be associated with the long-term intake of toxins and other substances, including Chinese herbs. The disease has typical radiological and endoscopic features. Radiologic examination combined with endoscopy can lead to a conclusive diagnosis. Patient concerns: We present 2 cases of IMP: in male patients aged 66 and 79 years. The first patient presented with diarrhea and abdominal pain, and the second patient presented with numbness of limbs and abdominal discomfort. These patients had a history of long-term use of Chinese herbal medicine (CHM). Diagnosis: Both patients were diagnosed with IMP by endoscopy and radiology, and the diagnosis confirmed by biopsy in the first patient. Interventions: The first patient was advised to stop using CHM. Both patients were given conservative treatment and were followed up regularly. Outcomes: Symptoms improved after conservative treatment. The patients had no obvious discomfort during the follow-up period. Conclusion: We suspect that the disease is induced by the long-term use of CHM, and dosage and duration of use may determine disease severity.

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

“…Guo et al [ 9 ] observed that the majority of patients were Asians, predominantly from Japan, Taiwan, and mainland China. The exact etiology and pathogenesis of IMP remain elusive but long-term exposure to toxins and biochemical substances may play a role[ 10 ]. Nearly all reported cases of IMP had a history of prolonged use of medicinal herbs containing geniposide, such as oldenlandia herbacea, plantaginis semen, eucommiae cortex, herba paederiae scandentis, radix scrophulariae, and fructus gardeniae[ 11 ].…”

“…The typical colonoscopy findings are a blue or bluish-purple mucosa, which may also display hyperemia, edema, erosion, or ulceration[ 6 ]. Histopathologically, IMP is characterized by venous wall thickening, fibrosis, and calcification, venous narrowing, atrophy, and submucosal fibrosis with intrinsic myometrium thickening[ 10 ]. Our patient presented with chronic diarrhea.…”

Intestinal obstruction due to idiopathic mesenteric phlebosclerosis colitis: A case report

“…The main CT findings of IMP included thickening of the affected colonic wall and linear calcification of the mesenteric vein. Typical endoscopic findings include a dark violaceous or blue intestinal wall in the diseased segment of the colon ( 17 ). This is likely caused by chronic congestion with ischemia or toxin contamination of the intestinal mucosa.…”

My approach to bowel ischaemia

“…This entity19–22 was first described among Oriental populations, for example, Chinese, Japanese and Korean. However, this predisposition is thought less likely to be genetic and more so due to ingestion of a compound especially found in Oriental medicines or herbal supplements, for example, geniposide in Gardenia fruit.…”