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• W2912298749 abstract "A 25-year-old woman was admitted with six months of bilateral lower abdominal pain, intermittent bloody diarrhea, tenesmus and twenty-pound weight loss. She had undergone an extensive work-up, starting with a flexible sigmoidoscopy at an outside hospital with findings thought to be consistent with ulcerative colitis and with biopsies that revealed edematous rectosigmoid mucosa concerning for ischemic colitis. She was started on an oral and rectal mesalamine and steroid with little symptom improvement. A subsequent colonoscopy with biopsies showed possible ischemic colitis with rectal aphthous ulcers. CT angiography demonstrated thickening of the distal descending and rectosigmoid colon with fat stranding. The patient was positive for Clostridium difficile, which was treated with two weeks of metronidazole. However, she continued to have abdominal pain. Given concern for colonic ischemia, a hypercoagulability work up revealed heterozygosity for Factor V Leiden, prompting initiation of anticoagulation. The pathology from the prior colonic biopsy was re-reviewed and demonstrated vascular changes strongly suggestive of venous outflow obstruction and consistent with idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV). IMHMV is pathologically defined by nonthrombotic, noninflammatory occlusion of the mesenteric veins secondary to intimal smooth muscle hyperplasia1. The etiology is unknown but thought to involve an acquired segmental arteriovenous fistulization2. The disease classically manifests in the rectosigmoid of young, healthy men and is characterized by abdominal pain, bloody diarrhea and weight loss1. Thus, it is often misdiagnosed as inflammatory bowel disease (IBD)3. IMHMV should be considered in patients with symptoms characteristic of IBD who do not improve with therapy. A colonic biopsy is necessary to differentiate the two entities. In IMHMV, biopsies may have ischemic or nonspecific findings and lack the typical features of IBD2. Surgical resection of the affected area can be curative after a prolonged, relapsing clinical course.Figure: Example of IMHMV. Histopathology of colon at 20x magnification demonstrating muscular thickening of the intramural veins (white arrow) with histologically unremarkable arteries (black arrow). Figure 1 used with permission from Patel AD, et al. Idiopathic Myointimal Hyperplasia of the Mesenteric Veins. ACG Case Reports Journal. 2016;3(4):e84." @default.
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• W2912298749 date "2017-10-01" @default.
• W2912298749 modified "2023-09-26" @default.
• W2912298749 title "The Great IBD Imitator: A Case of Idiopathic Myointimal Hyperplasia of the Mesenteric Veins" @default.
• W2912298749 doi "https://doi.org/10.14309/00000434-201710001-01438" @default.
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