J Korean Med Sci.  2009 Dec;24(6):1195-1199. 10.3346/jkms.2009.24.6.1195.

Phlebosclerotic Colitis in a Cirrhotic Patient with Portal Hypertension: The First Case in Korea

• Kang HY
• Noh R
• Kim SM
• Shin HD
• Yun SY
• Song IH

• KMID: 1783155
• DOI: http://doi.org/10.3346/jkms.2009.24.6.1195

Abstract

Phlebosclerotic colitis is a rare form of ischemic colitis characterized by the thickening of the wall of the affected colon due to fibrous degeneration of submucosal layer of colon and fibrotic obstruction of the colono-mesenteric vein, resulting in the disturbance of venous return from the colon. The pathogenic mechanism of this entity remains unknown but chronic liver disease with portal hypertension is maybe thought to be one of the speculated mechanisms. Here we first report the case of surgically confirmed phlebosclerotic colitis, that was in the early stage but showed the aggressive nature, in a 61-yr-old cirrhotic patients with portal hypertension in Korea.

Keyword

Colitis, Ischemic; Liver Cirrhosis; Hypertension, Portal; Sclerosis

MeSH Terms

Colitis/pathology
Colon/blood supply/*pathology
Colonoscopy
Humans
Hypertension, Portal/*pathology
Korea
Liver Cirrhosis/pathology
Male
Middle Aged
Tomography, X-Ray Computed

Figure

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  Fig. 1 A colonoscopy revealed multiple circumferential ulcerations in the distal ascending and transverse colon (A), and the follow-up colonoscopy performed one month later showed still remained multiple ulcerations in the transverse colon and the scope could not get through the further proximal portion of ascending colon due to stenosis and fibrosis (B).

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  Fig. 2 Abdominal CT disclosed thickening of the wall of the ascending colon with surrounding fatty infiltration and diffuse vascular engorgement (A). Virtual CT colonography showed marked luminal narrowing with shortening of ascending colon (B).

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  Fig. 3 Superior mesenteric angiography revealed no occlusion of main branch at arterial phase (A), and indicated venous pooling (arrows) along the ascending colon at the delayed phase (B).

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  Fig. 4 Abdominal CT showed markedly dilated small bowel and a portion of colonic wall thickening.

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  Fig. 5 Macroscopic examination showed a huge ulcerating mass-like lesion (dotted circle) at the cecum and the proximal ascending colon measuring about 7×5 cm with colonic wall thickening (A). Microscopic examination showed fibrous thickening (arrow) of the mesenteric vein (B) (H&E, ×200), (C) prominent neurovascular bundles and eosinophilic inflammation in submucosa (arrows) (H&E, ×40), and (D) chronic ulcerative inflammation (H&E, ×100) with no evidence of malignancy.

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