Conservative treatment of idiopathic mesenteric phlebosclerosis

Ischemic bowel disease is caused by occlusion or stenosis either of the mesenteric artery or, less frequently, of the vein. Phlebosclerotic colitis is a rare chronic and gradually worsening ischemic colitis caused by mesenteric phlebosclerosis, and its symptoms are the gradual onset of right-side abdominal pain with or without diarrhea, and recurrent ileus. The most commonly affected site is the region from the terminal ileum to the sigmoid colon, particularly the cecum and ascending colon. The characteristic radiologic findings of mesenteric phlebosclerosis are luminal narrowing, wall thickening of the affected colon (typically the proximal colon), and calcification of the mesenteric veins. The diagnosis may be made on the basis of imaging findings. We report on a 59-year-old man with periumbilical abdominal pain for 1 week. The pain was dull and persistent. A physical examination revealed a soft, tender abdomen with normoactive bowel sounds and mild rebounding tenderness in the right upper abdomen. The abdominal plain X-ray and abdominal computed-tomography findings were compatible with idiopathic mesenteric phlebosclerosis. The symptoms resolved after only conservative treatment, and the disease did not recur during 5 years of follow-up. Idiopathic mesenteric phlebosclerosis is a rare disease, and its pathogenesis is not yet clearly understood; however, it differs from other rare causes of nonthrombotic mesenteric venous occlusion. Idiopathic mesenteric phlebosclerosis can be diagnosed on the basis of imaging findings, and most symptoms resolve only after conservative treatment.