Phlebosclerotic colitis: an analysis of clinical and CT findings in 29 patients with long-term follow-up

Abstract

Background Phlebosclerotic colitis (PC) is a rare form of nonthrombotic colonic ischemia. This retrospective study analyzed the clinical findings and temporal CT changes in 29 PC patients with long-term follow-up. Methods Twenty-nine patients with characteristic CT features of PC collected between 1997 and 2020 were stratified into the acute abdomen group (AA-group) (n = 10), chronic-progressive group (CP-group) (n = 14) and chronic-stable group (CS-group) (n = 5). Clinical and CT changes during follow-up, comorbidities and final outcomes were compared. Results The AA-group exhibited a significantly thicker colonic wall and more involved segments and pericolic inflammation than the CP-group and CS-group on initial CT (p = < 0.001–0.031). Seven patients in the AA-group who underwent right hemicolectomy had no recurrence during follow-up (mean ± SD, 7.1 ± 3.3 years), and the remaining three patients with renal or hepatic comorbidities who underwent conservative treatment died within 14 days. The CP-group showed significantly higher frequencies of chronic renal failure, urinary tract malignancies and liver cirrhosis than the AA-group (p = 0.005–0.008). In addition, CT follow-up (7.9 ± 4.3 years) showed significant increases in mesenteric venous calcifications, colonic wall thickening and involved colonic segments (p = 0.001–0.008) but conservative treatments were effective. The CS-group remained unchanged for years (8.2 ± 3.9 years). Conclusions Early surgery offered excellent prognosis in PC-related acute abdomen denoted by marked right colonic wall thickening and pericolic inflammation on CT. Conservative treatments with a wait-and-watch strategy were appropriate for CP-PC and CS-PC, albeit CP-PC harbored significant increases in calcifications, colonic wall thickening and affected segments in long-term CT follow-up.

Clinical significance of abdominal computed tomography and colonoscopy in the evaluation of phlebosclerotic colitis

“…More severe mesenteric venous calcification, increased involvement of colonic segments, thicker colonic wall, and the presence of pericolic inflammation seem associated with a higher frequency of clinical symptoms and are indicative of the need for surgery. 1,3,4 In our study, all patients demonstrated varying degrees of venous calcification and colonic wall thickness. Pericolic inflammation was observed in 26 patients (57.78%).…”

“…This heterogeneity underscores the need for diverse treatment approaches, ranging from supportive care to surgical intervention. [1][2][3][4][5] Mild symptoms can be managed by observation or symptomatic relief medications, whereas severe symptoms necessitate surgical intervention.…”

“…Only limited research investigated the association between CT features and disease severity. 1,3,4,9 Additionally, no large-scale study analyzing the correlation between colonoscopic findings and disease severity. Hence, we conducted a retrospective analysis with the objective of investigating the relationship between CT and colonoscopy features with disease severity as well as explore the correlation between CT characteristics and colonoscopy features in PC patients to increase the understanding of this condition and aid in the selection of appropriate treatment strategies.…”

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

“…However, Chen et al found that only four of 25 Chinese patients with IMP had history of long-term use of traditional Chinese medicinal materials and medicinal liquor ( 10 ). In a study by Sheung et al involving 29 patients with venous sclerosing colitis, only six used various herbal medicines, and a significant association between herbal medicines and IMP was not established ( 11 ). According to a systematic review of 240 reports by Wang et al, 78.7% of patients had history of herbal medicine intake ( 12 ).…”

“…IMP is pathologically characterized by mucosal ulceration, epithelial ischemic atrophy of the intestinal wall, extensive fibrosis and hyalinization of the submucosa ( 16 ), and marked calcification within the venous wall narrowed by non-inflammatory fibrosis ( 11 ). The clinical signs of IMP are nonspecific and include chronic abdominal pain, diarrhea, and anemia.…”