Idiopathic mesenteric phlebosclerosis caused by traditional medicine in a married couple and review of literature

摘要

A 53-year-old woman presented with intermittent abrupt abdominal pain and occasional lower gastrointestinal bleeding for two years. She had taken a commercial Chinese tradition medicine (Da Chai Hu Tang) intermittently for health promotion for duration of five years. Idiopathic mesenteric phlebosclerosis was diagnosed by characteristic image findings including right side thread-like calcifications on plain abdominal film, thickened ascending colon wall and venous calcification on computed tomography (CT) scans, and hyperechoic spots of thickened ascending colon wall on abdominal ultrasonography, which is reported for the first time in literature. The colonoscopy showed dark blue pigmentation on the mucosa around ulceration and loss of semilunar colon folds that is compatible to idiopathic mesenteric phlebosclerosis. Surgical intervention with right hemicolectomy was done for recurrent compromised symptoms. Her husband who took the same traditional medicine also was found to have the same disease in the following year. The toxic theory of idiopathic mesenteric phlebosclerosis was supported by two genetically irrelevant patients exposed to the same drug. Idiopathic mesenteric phlebosclerosis should be considered when image studies including ultrasonography show hyperechoic spots in thickened colon wall.