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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