Intest Res.  2016 Oct;14(4):369-374. 10.5217/ir.2016.14.4.369.

Obstructive ileus caused by phlebosclerotic colitis

• Lee SH
• Kim JW
• Park SJ
• Heo JY
• Paik WH
• Bae WK
• Kim NH
• Kim KA
• Lee JS

• KMID: 2354956
• DOI: http://doi.org/10.5217/ir.2016.14.4.369

Abstract

A 57-year-old man with chronic kidney disease and a history of using numerous herbal medications visited Inje University Ilsan Paik Hospital for abdominal pain and vomiting. An abdominal radiograph showed diffuse small bowel distension containing multiple air-fluid levels and extensive calcifications along the colon. Computed tomography showed colon wall thickening with diffuse calcification along the colonic mesenteric vein and colonic wall. Colonoscopy, performed without bowel preparation, showed bluish edematous mucosa from the transverse to the distal sigmoid colon, with multiple scar changes. At the mid transverse colon, a stricture was noted and the scope could not pass through. A biopsy of the stricture site revealed nonspecific changes. The patient was diagnosed with phlebosclerotic colitis. After the colonoscopy, the obstructive ileus spontaneously resolved, and the patient was discharged without an operation. Currently, after 2 months of follow-up, the patient has remained asymptomatic. Herein, we report the rare case of an obstructive ileus caused by phlebosclerotic colitis with a colon stricture.

Keyword

Phlebosclerotic colitis; Phlebosclerosis; Herbal medicine; Ileus

MeSH Terms

Abdominal Pain
Biopsy
Cicatrix
Colitis*
Colon
Colon, Sigmoid
Colon, Transverse
Colonoscopy
Constriction, Pathologic
Follow-Up Studies
Herbal Medicine
Humans
Ileus*
Mesenteric Veins
Middle Aged
Mucous Membrane
Renal Insufficiency, Chronic
Vomiting

Figure

• 

  Fig. 1 Plain abdominal radiograph. Initial plain abdominal radiograph shows a diffuse small bowel ileus with multiple air-fluid levels and numerous calcification densities along the colon. (A) Supine, (B) Erect. Dramatically improved ileus, 1 day after the colonoscopy. (C) Supine, (D) Erect.

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  Fig. 2 Non-contrast-enhanced abdominal CT scan. (A) Diffuse fluid-filled distension of A B small bowel. (B) Colonic wall calcifications.

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  Fig. 3 Colonoscopy findings. (A) Pinpoint stricture in the transverse colon, scope passage was not possible. (B) Blue-grayish congestive change with diffuse scarring found in the transverse colon.

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  Fig. 4 Pathologic findings at the stricture site. The mucosa shows lymphoid cell infiltration and mild architectural distortion of crypts, which are suggestive of regenerative changes (H&E, ×100). No submucosal vessel was included in the specimen.

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  Fig. 5 Contrast-enhanced abdominal CT angiography. Abdominal CT scan shows extensive calcifications along the colonic wall (thick arrow) and mesenteric veins (thin arrow).

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