Mesenteric phlebosclerosis - A new disease entity causing ischemic colitis
Mesenteric phlebosclerosis - A new disease entity causing ischemic colitis
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DOI：
10.1007/s10350-004-6526-0
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发表时间：
2003-02-01
影响因子：
3.9
通讯作者：
Kikuchi, M
中科院分区：
文献类型：
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作者：
Iwashita, A;Yao, T;Kikuchi, M
目的：非血栓性肠系膜静脉狭窄或闭塞是肠缺血的罕见原因。本研究的目的是描述一种引起慢性缺血性结肠炎的新疾病实体。方法：诊断为肠系膜静脉硬化的患者7例。7例患者均有肠系膜小静脉及其壁内分支钙化。没有血管炎或门静脉高压症的证据。所有患者均无胃肠道疾病史或长期用药史。我们报告临床、实验室、放射学、内窥镜和组织病理学的发现。结果：临床表现包括腹痛和腹泻的逐渐发作和慢性过程。粪便隐血试验阳性和轻度贫血常被发现。患者分别通过腹部平片和钡灌肠发现右结肠线性钙化和狭窄。内窥镜检查结果包括水肿，深色粘膜和溃疡。4例患者因持续腹痛或肠梗阻行结肠次全切除术。病理组织学表现为宏观上结肠表面呈深紫色或深褐色，结肠半月皱襞肿胀消失，结肠壁明显增厚；微观上静脉壁纤维增厚，钙化明显，粘膜下纤维化明显，粘膜胶原沉积，血管壁内可见泡沫状巨噬细胞。结论：这些特殊的病变以前没有被充分描述。我们认为这种病变代表了一种新的临床病理疾病实体，并提出了“特发性肠系膜静脉硬化”这一术语。
PURPOSE: Nonthrombotic stenosis or occlusion of the mesenteric veins is a rare cause of intestinal ischemia. The aim of this study was to describe a new disease entity causing chronic ischemic colitis. METHODS: Seven patients were diagnosed as having mesenteric phlebosclerosis. All seven patients had calcifications in the small mesenteric veins and their intramural branches. No evidence of vasculitis or portal hypertension was recognized. None of the patients had a history of gastrointestinal disease or of prolonged drug use. We report clinical, laboratory, radiographic, endoscopic, and histopathologic findings. RESULTS: Clinical findings included abdominal pain and diarrhea of a gradual onset and chronic course. A positive fecal occult blood test and mild anemia were often found. The patients had linear calcifications and stenosis in the right colon, which were discovered by plain abdominal radiography and barium enema, respectively. Endoscopic findings included edematous, dark colored mucosa and ulcerations. Four patients underwent a subtotal colectomy because of persistent abdominal pain or ileus. The histopathologic findings were macroscopic ally characterized by a dark purple or dark brown colored colonic surface, the swelling and disappearance of plicae semilunares coli, and marked thickening of the colonic wall, while them were micro scopically characterized by marked fibrous thickening of the venous walls with calcifications, marked submucosal fibrosis, deposition of collagen in the mucosa, and foamy macrophages within the vessel walls. CONCLUSIONS: These peculiar lesions have not previously been fully described. The cause and pathogenesis still remain unknown, We conclude that such lesions represent a new clinicopathologic disease entity and propose the term "idiopathic mesenteric phlebosclerosis.".