A rare etiology of partial intestinal obstruction and sepsis: idiopathic mesenteric phlebosclerosis

A 64-year-old woman presented with abdominal pain and vomiting for 4 days. She had a medical history of long-term use of traditional Chinese medicine prescribed by her family doctor for more than 10 years. Blood biochemistry tests showed an increase in leukocytosis (WBC 17.18 × 10⁹/L, 88% neutrophils) and elevated procalcitonin (76.42 ng/mL), indicating a systemic infection. Notably, noncontrast abdominal CT revealed signs of incomplete bowel obstruction, especially characteristic mesenteric vessel calcification and colonic wall thickening in the cecum ([Fig. 1]). After empirical treatment with broad-spectrum antibiotics (ertapenem and teicoplanin) for suspected sepsis, the patient’s condition improved, procalcitonin levels returned to normal, and the gastrointestinal function was restored. We then performed a routine colonoscopy and found that the confined colonic mucosa had a dark-purple discoloration, similar to widespread varicosities. When the colon is fully inflated, normal mucosa between the dark purple areas corresponding to the submucosal veins could be observed, which, combined with the patient's previous medication history, clinical manifestations, abdominal CT, and colonoscopy, the patient can be clearly diagnosed with IMP ([Fig. 2], [Video 1]). After conservative treatment, the patientʼs abdominal pain and vomiting resolved and she tolerated a soft diet. Upon discharge, instructions were given to stop taking traditional Chinese herbal medicines, and polyethylene glycol 4000 was prescribed to maintain bowel regularity.

Fig. 1 Noncontrast abdominal CT showing extensive calcification and uniform thickening of the colonic wall.

Fig. 2 a Terminal ileum; b cecum; c ascending colon; d transverse colon; e sigmoid colon, closely examined after adequate insufflation; f rectum.

This video demonstrates the colonoscopic findings of idiopathic mesenteric phlebosclerosis (IMP), highlighting dark-purple discoloration of the colonic mucosa and normal areas between varicosities.Video 1

IMP is a rare chronic venous disease characterized by mesenteric vein calcification, often associated with the long-term use of Chinese herbal medicines [1]. Diagnosis can be delayed because of the nonspecific presentation [2] [3]. Key diagnostic points include long-term use of traditional Chinese medicine, mesenteric vascular calcification on CT imaging, and colonoscopic findings of diffuse dark-purple discoloration of the mucosa, resembling widespread varicosities, with lesions confined to the colon [4].

Endoscopy_UCTN_Code_CCL_1AD_2AF

 

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Jin YR, Zhou H, Liu ZZ. et al. Idiopathic mesenteric phlebosclerosis occurring after long-term medication with licorice: A case report. J Digest Dis 2022; 23: 183-185
• 2 Tong T, Fu J, Kong Y. Recurrent Abdominal Pain in a 61-Year-Old Woman. Gastroenterology 2023; 164: 887-890
• 3 Nishiura H, Nakase H, Chiba T. Sustained abdominal discomfort in a 57-year-old woman. Idiopathic mesenteric phlebosclerosis. Gut 2010; 59: 578-594
• 4 Li H, Liu H. Idiopathic Mesenteric Phlebosclerosis. Radiology 2023; 306: 76

Publication History

Article published online:
22 May 2025