Idiopathic myointimal hyperplasia of mesenteric veins mimicking steroid-refractory ulcerative colitis: A case report

Authors:
  • JLJu Seok Lee
    Ju Seok Lee
  • EKEun Young Kim
    Eun Young Kim
  • JKJoong Goo Kwon
    Joong Goo Kwon
  • JBJune Hwa Bae
    June Hwa Bae
  • MKMina Kim
    Mina Kim
  • CYChun-Seok Yang
    Chun-Seok Yang
  • SYSeong Ho Yu
    Seong Ho Yu
  • CCChang-Ho Cho
    Chang-Ho Cho
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Abstract
BACKGROUND Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is a rare, non-thrombotic venous occlusive disease that causes chronic intestinal ischemia and frequently mimics inflammatory bowel disease, particularly ulcerative colitis. Because clinical, endoscopic, and radiologic findings are nonspecific, IMHMV is often misdiagnosed, leading to delayed definitive treatment. CASE SUMMARY A 65-year-old man with a history of living-donor liver transplantation presented with a 6-month history of watery diarrhea and abdominal pain. He was receiving tacrolimus and mycophenolate mofetil for immunosuppression. Colonoscopy demonstrated continuous colitis extending from the mid-transverse colon to the rectum, and mucosal biopsies showed only nonspecific chronic inflammation. Despite treatment with mesalazine, corticosteroids, and filgotinib, the patient showed progressive clinical deterioration and developed massive hematochezia requiring emergent open subtotal colectomy with end transverse colostomy and rectal stump preservation. Histopathologic examination of the resected specimen revealed marked myointimal hyperplasia of mesenteric veins with near-complete luminal obliteration and subendothelial fibrin deposition, while arterial structures were preserved, confirming IMHMV. Postoperatively, inflammation recurred in the rectal stump and improved with topical mesalazine therapy. CONCLUSION IMHMV should be considered in patients with steroid-refractory colitis and nonspecific biopsy findings. This case highlights the diagnostic limitations of mucosal biopsy, the importance of histopathologic confirmation, and the need for careful interpretation of postoperative rectal inflammation, in which diversion colitis and underlying inflammatory bowel disease may overlap.

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