Extensive idiopathic mesenteric phlebosclerosis presenting as intestinal pseudo-obstruction: A case report

Idiopathic mesenteric phlebosclerosis (IMP) is a rare condition that causes ischaemic colitis, has various clinical manifestations, and may even be asymptomatic, often resulting in clinical misdiagnosis.

We report the case of a 44-year-old woman with chief complaints of abdominal pain, vomiting and decreased defecation. One year prior, the patient was asymptomatic and therefore misdiagnosed with inflammatory bowel disease based on incidental findings on an abdominal computed tomography (CT) scan. The present abdominal CT scan revealed an intestinal obstruction, diffuse thickening of the entire colon wall and calcification of the mesenteric and colonic veins. Colonoscopy revealed multiple ulcerations and extensive dark purple discolouration of the oedematous mucosa. Colonic transit studies suggested a decrease in colonic motility. IMP was considered the underlying cause of her pseudoileus, which was potentially linked to her consumption of Chinese medicinal teas for more than 30 years. The patient underwent conservative medical treatment, and her symptoms gradually improved. She exhibited no signs of ileus or other significant discomfort at the outpatient follow-up one year after the discontinuation of Chinese herbal tea consumption.

IMP can present with symptoms of pseudoileus as initial complication. Clinicians can use CT and colonoscopy for differential diagnoses.