J Rheum Dis.  2014 Apr;21(2):101-105. 10.4078/jrd.2014.21.2.101.

A Case of Enterocolic Lymphocytic Phlebitis Mimicking Surgical Abdomen

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea. hjchoi@gilhospital.com
  • 2Department of Pathology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Vasculitis that involves the gastrointestinal (GI) tract often occurs as part of a systemic inflammatory process. It is a well-recognized manifestation of the small and medium sized vessel vasculitides. Vasculitis of the GI tract may occur in isolation; although it can progress to a systemic illness. It usually involves the arterioles, venules, and capillaries; however, it is very rare for only the venules to be affected. Enterocolic lymphocytic phlebitis is a localized vasculitis, typically affecting the small and medium-sized intramural and mesenteric veins of the intestines. We report a case of enterocolic lymphocytic phlebitis of the colon. A 38-year-old woman was presented with hematochezia and severe abdominal pain on the day of admission. She had no history of intestinal disease or systemic disease. Computed tomography showed an extremely thickened wall of the colon, along with several air bubbles in the colon with diffuse subcutaneous emphysema in the abdominal wall. An emergency exploration laparotomy and extended right hemicolectomy was performed. The patient recovered completely after surgery and remains well without further therapy.

Keyword

Enterocolic lymphocytic phlebitis; Localized gastrointestinal vasculitis; Single-organ vasculitis

MeSH Terms

Abdomen*
Abdominal Pain
Abdominal Wall
Adult
Arterioles
Capillaries
Colon
Emergencies
Female
Gastrointestinal Hemorrhage
Gastrointestinal Tract
Humans
Intestinal Diseases
Intestines
Laparotomy
Mesenteric Veins
Phlebitis*
Subcutaneous Emphysema
Vasculitis
Venules

Figure

  • Figure 1. Abdominal CT shows an extremely thickened wall of the ascending colon (arrow) with diffuse scattered subcutaneous emphysema in the abdominal wall.

  • Figure 2. Gross features of the specimen. An ill defined lesion with irregular surface is localized in ascending colon. The mucosa of the lesion is necrotic, stiff and reddish.

  • Figure 3. Microscopic findings of enterocolic phlebitis. The lesional mucosa and submucosa are shown in (A). The mucosa reveals ischemic necrosis and the submucosa is hemorrhagic and edematous. The submucosal veins of the lesion (B) are filled with thrombi, and show necrotizing vasculitis with fibrinoid degeneration. The vessels at the periphery (C and D) show lymphocytic phlebitis, relatively. Special stain for elastin (D) demonstrated that arteries are spared. (A-C, Hematoxylin-eosin stain ×200; D, Elastic stain ×200).


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