Gastrointestinal: Phlebosclerotic colitis

Ischemic injury to the large bowel is relatively common. In typical patients, this is caused by a transient perfusion defect in the superior mesenteric artery, inferior mesenteric artery or both arteries. The most common sites for ischemic injury are the splenic flexure, descending colon and sigmoid colon that reflect watershed areas between the circulations of the superior and inferior mesenteric arteries. Other causes of ischemic injury include small and large vessel vasculitis and a rare disorder that has been called phlebosclerotic colitis. In the latter disorder, colitis has been attributed to obstruction of veins in the intestinal wall and adjacent mesentery. This usually affects the cecum and ascending colon and results in thickening of the colonic wall, colonic fibrosis with strictures and fibrotic sclerosis of the venous wall, often with the development of venous wall calcification. The cause remains unclear but some patients have chronic liver disease with portal hypertension. Symptoms are often minor but include pain in the right iliac fossa and rectal bleeding. Thus far, the majority of reports have come from Japan. In this report, we described the progression of asymptomatic phlebosclerotic colitis over a period of 5 years. The patient was a 68-year-old man who was investigated by colonoscopy because of a positive fecal occult blood test in 2000. Colonoscopy revealed deformity of the cecum and a small area of ulceration in the ascending colon. Colonoscopy was repeated at yearly intervals (Fig. 1) and revealed progressive scarring of the cecum and ascending colon. Colonic ulcers were identified in 2003 and there was narrowing of the cecum and ascending colon in 2004 and 2005. The appearance on computed tomography scans is shown in Fig. 2. There was thickening of the wall of the cecum and ascending colon and prominent calcification in the colonic wall (arrows). Calcification was also present in the extra-colonic branches of the ileo-colic and right colic veins (lower right panel). Thus far, the patient has not experienced any significant abdominal symptoms. However, some patients do develop obstructive symptoms that require treatment by surgical resection.