Rationale: Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease with unclear etiology and pathogenesis. Although most IMP patients have a long-term history of traditional Chinese herbal medicine use, this article reports a case without such a special medical history, which may provide new insights into the disease’s etiology. Patient concerns: A 59-year-old middle-aged man was admitted to the gastroenterology department due to recurrent upper abdominal pain for 1 month. The fecal occult blood test was weakly positive. Diagnoses: No significant abnormalities were found in tumor markers, Epstein–Barr virus, cytomegalovirus, T-SPOT, tuberculosis antibodies, or coagulation function. Computed tomography revealed edema and thickening of the intestinal wall in the ascending colon and part of the transverse colon, accompanied by narrowing of the lumen. Multiple calcifications were observed in the right mesenteric vessels, associated with the affected areas. Colonoscopy findings: a circumferential ulcer was noted in the ascending colon at a distance of 75 to 60 cm from the anus, with partial cyanosis of the mucosa and nodular changes. During hospitalization, a series of tests was conducted, and the final diagnosis was IMP. Interventions: The patient received conservative treatment during hospitalization. Outcomes: After conservative treatment, the patient’s abdominal pain and hematochezia improved, and the findings of computed tomography and colonoscopy also showed improvement in the condition. To date, the patient has not experienced any significant discomfort during follow-up. Lesson: Diagnosing IMP requires familiarity with its characteristic features and the ability to interpret relevant imaging findings. It is important to note that long-term use of traditional Chinese herbal medicine is not always the cause. Further research, including the analysis of more clinical cases and the performance of animal experiments, is needed to fully understand the etiology and pathogenesis of IMP.
Rao et al. (Fri,) studied this question.