Yamada Kohei, Hiraki Masatsugu, Tanaka Toshiya, Mori Daisuke, Tanaka Futoshi, Manabe Tatsuya, Aibe Hitoshi, Kitahara Kenji, Noshiro Hirokazu
Department of Surgery, Saga Medical Centre Koseikan, 400 Kasemachi, Nakabaru, Saga, 840-8571, Japan.
Department of Pathology, Saga Medical Centre Koseikan, 400 Kasemachi, Nakabaru, Saga, 840-8571, Japan.
Surg Case Rep. 2021 Jan 13;7(1):17. doi: 10.1186/s40792-020-01100-8.
Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare ischemic bowel disease with venous occlusion resulting from the proliferation of smooth muscles in the venous intima. In most patients, the disease affects rectosigmoid colon and causes persistent abdominal pain and hematochezia, which is similar to inflammatory bowel disease (IBD). In addition, it is difficult to make a precise diagnosis of IMHMV without surgery.
An 81-year-old woman was admitted to our hospital with mild abdominal pain, nausea and vomiting. Repeated adhesive ileus was suspected due to the previous open and laparoscopic surgeries. Surgery was planned to treat small bowel obstruction. Intraoperatively no adhesive lesions were observed. However, a mass lesion was seen at the terminal ileum, which was suspected to have caused her bowel obstruction. Partial resection of the small intestine was performed. Macroscopic and histopathological examinations of the excised specimen showed circumferential ulceration with scarring, a thickened venous wall with active inflammation, and fibrotic changes that consequently produced stenosis and obstruction of the venous lumen in the subserosa. Additionally, Elastica van Gieson staining demonstrated thickening of the venous intima. The final diagnosis was IMHMV. At two years and 8 months after the operation, the patient was well without any additional medication.
IMHMV of the small intestine is rare. We described a case of IMHMV that was associated with ileus.
肠系膜静脉特发性肌内膜增生（IMHMV）是一种罕见的缺血性肠病，静脉内膜平滑肌增生导致静脉闭塞。在大多数患者中，该病累及直肠乙状结肠，引起持续性腹痛和便血，这与炎症性肠病（IBD）相似。此外，未经手术很难对IMHMV做出准确诊断。
一名81岁女性因轻度腹痛、恶心和呕吐入院。由于既往有开腹手术和腹腔镜手术史，怀疑为反复粘连性肠梗阻。计划行手术治疗小肠梗阻。术中未观察到粘连性病变。然而，在回肠末端发现一个肿块病变，怀疑是导致其肠梗阻的原因。遂行小肠部分切除术。对切除标本进行大体和组织病理学检查，结果显示有瘢痕形成的环形溃疡、静脉壁增厚伴活动性炎症以及纤维化改变，进而导致浆膜下静脉腔狭窄和阻塞。此外，弹力纤维染色显示静脉内膜增厚。最终诊断为IMHMV。术后两年零八个月，患者情况良好，无需任何额外药物治疗。
小肠IMHMV较为罕见。我们描述了一例与肠梗阻相关的IMHMV病例。
