Idiopathic Mesenteric Phlebosclerotic Colitis: A Case Report

不明原因腸系膜靜脈硬化是引起慢性腸道缺血的一個罕見原因。在臨床上，主要是以慢性腹痛或腹瀉表現，但因其為非特異症狀，所以診斷上常會延誤。確定診斷主要是靠放射線檢查看到腸系膜靜脈線狀鈣化，加上病理學上特殊的表現來加以診斷。但其確切的病因及致病機轉，目前並無定論。本文報告一名46歲女性，有慢性腹痛及腹瀉症狀已達10年，並有體重減輕約20公斤。住院時大腸內視鏡檢查發現瀰漫性大腸潰瘍，初步診斷為發炎性大腸疾病，於門診追蹤治療；但出院兩週後因急性腹痛至急診，接受腹部X光及腹部電腦斷層檢查時，始發現有腸系膜靜脈鈣化及狹窄，並有游離空氣，懷疑有腸穿孔。病患接受緊急手術，病理檢查診斷為不明原因腸系膜靜脈硬化性大腸炎。此病患終因重度營養不良，術後併發敗血症而死亡。期望藉由本病例報告，讓臨床醫師對此潛在致命的疾病多加了解。

關鍵字

不明原因腸系膜靜脈硬化症；腸系膜靜脈硬化性大腸炎；慢性腹瀉；慢性腹痛

並列摘要

Idiopathic mesenteric phlebosclerosis (IMP) is a rare cause of chronic intestinal ischemia. Its clinical manifestations include chronic abdominal pain and/or chronic diarrhea, which are nonspecific and often lead to a delayed diagnosis. IMP is diagnosed based on characteristic radiographic findings of threadlike calcifications in the mesenteric veins coupled with unique pathologic findings. The cause of the disease and pathogenesis remain unknown. Herein, we present a 46-year-old woman who was hospitalized with complaints of chronic abdominal pain and diarrhea for 10 years and a loss of 20 kg in body weight. Colonoscopy revealed diffuse ulcerations and treatment for inflammatory bowel disease was administered. Two weeks after discharge, she returned to our emergency department because of acute abdominal pain. Plain abdominal radiography and computed tomography revealed calcifications and stenosis of the mesenteric veins and accumulation of free air, indicating possible colonic perforation. Emergency surgical intervention and a subtotal colectomy and ileostomy were performed. Pathologic findings confirmed the diagnosis of mesenteric phlebosclerotic colitis. Her postoperative course was complicated by sepsis and she died on postoperative day 3. We hope that this report serves to alert physicians of this potentially lifethreatening disease.

並列關鍵字

idiopathic mesenteric phlebosclerosis ； mesenteric phlebosclerotic colitis ； chronic diarrhea ； chronic abdominal pain

國際替代計量

Idiopathic Mesenteric Phlebosclerotic Colitis: A Case Report

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