Kohei Yamada1, Masatsugu Hiraki2, Toshiya Tanaka1, Daisuke Mori3, Futoshi Tanaka1, Tatsuya Manabe4, Hitoshi Aibe5, Kenji Kitahara1, Hirokazu Noshiro4. 1. Department of Surgery, Saga Medical Centre Koseikan, 400 Kasemachi, Nakabaru, Saga, 840-8571, Japan. 2. Department of Surgery, Saga Medical Centre Koseikan, 400 Kasemachi, Nakabaru, Saga, 840-8571, Japan. masatsuguhiraki@hotmail.com. 3. Department of Pathology, Saga Medical Centre Koseikan, 400 Kasemachi, Nakabaru, Saga, 840-8571, Japan. 4. Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan. 5. Department of Radiology, Saga Medical Centre Koseikan, 400 Kasemachi, Nakabaru, Saga, 840-8571, Japan.
Abstract
BACKGROUND: Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare ischemic bowel disease with venous occlusion resulting from the proliferation of smooth muscles in the venous intima. In most patients, the disease affects rectosigmoid colon and causes persistent abdominal pain and hematochezia, which is similar to inflammatory bowel disease (IBD). In addition, it is difficult to make a precise diagnosis of IMHMV without surgery. CASE PRESENTATION: An 81-year-old woman was admitted to our hospital with mild abdominal pain, nausea and vomiting. Repeated adhesive ileus was suspected due to the previous open and laparoscopic surgeries. Surgery was planned to treat small bowel obstruction. Intraoperatively no adhesive lesions were observed. However, a mass lesion was seen at the terminal ileum, which was suspected to have caused her bowel obstruction. Partial resection of the small intestine was performed. Macroscopic and histopathological examinations of the excised specimen showed circumferential ulceration with scarring, a thickened venous wall with active inflammation, and fibrotic changes that consequently produced stenosis and obstruction of the venous lumen in the subserosa. Additionally, Elastica van Gieson staining demonstrated thickening of the venous intima. The final diagnosis was IMHMV. At two years and 8 months after the operation, the patient was well without any additional medication. CONCLUSION: IMHMV of the small intestine is rare. We described a case of IMHMV that was associated with ileus.
BACKGROUND:Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare ischemic bowel disease with venous occlusion resulting from the proliferation of smooth muscles in the venous intima. In most patients, the disease affects rectosigmoid colon and causes persistent abdominal pain and hematochezia, which is similar to inflammatory bowel disease (IBD). In addition, it is difficult to make a precise diagnosis of IMHMV without surgery. CASE PRESENTATION: An 81-year-old woman was admitted to our hospital with mild abdominal pain, nausea and vomiting. Repeated adhesive ileus was suspected due to the previous open and laparoscopic surgeries. Surgery was planned to treat small bowel obstruction. Intraoperatively no adhesive lesions were observed. However, a mass lesion was seen at the terminal ileum, which was suspected to have caused her bowel obstruction. Partial resection of the small intestine was performed. Macroscopic and histopathological examinations of the excised specimen showed circumferential ulceration with scarring, a thickened venous wall with active inflammation, and fibrotic changes that consequently produced stenosis and obstruction of the venous lumen in the subserosa. Additionally, Elastica van Gieson staining demonstrated thickening of the venous intima. The final diagnosis was IMHMV. At two years and 8 months after the operation, the patient was well without any additional medication. CONCLUSION: IMHMV of the small intestine is rare. We described a case of IMHMV that was associated with ileus.