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Session: ePoster: IBD 1 (Sun8)

EP309 - Unmasking the Elusive: A Two-Case Series of Idiopathic Myointimal Hyperplasia of Mesenteric Veins Mimicking Colonic Ischemia”

Sunday, May 11, 2025
9:38 AM – 9:43 AM PT
Location: Monitor 6, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Stefano Tassinari, MD

    General Surgery Resident
    Johns Hopkins Hospital
    Laurel, MD, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • SN

    Shuait Nair, BSFS

    Medical Student
    Johns Hopkins University School of Medicine
    Baltimore, Maryland, United States

    Disclosure information not submitted.

  • Leonardo Garcia, MD

    Colon and Rectal Surgery Fellow
    Brigham and Women's Hospital
    The Johns Hopkins Hospital
    Chestnut Hill, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Laura C. Perez Arteaga, MD

    Resident Phycisian
    University of Colorado School of Medicine
    Denver, CO, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • JB

    Jacqueline E. Birkness-Gartman, MD

    Assistant Professor
    Johns Hopkins University School of Medicine
    Baltimore, Maryland, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Susan Gearhart, MD

    Associate Professor of Surgery
    Johns Hopkins Medicine
    Baltinore, Maryland, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Stefano Tassinari, MD: This individual has no financial relationships with ineligible companies.
Leonardo Garcia, MD: This individual has no financial relationships with ineligible companies.
Laura C. Perez Arteaga, MD: This individual has no financial relationships with ineligible companies.
Susan Gearhart, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is an exceedingly rare condition characterized by a veno-occlusive disease of the intestine. It is characterized by smooth muscle proliferation of the mesenteric veins. Given its rarity, the incidence of IMHMV remains unknown. Preoperative diagnosis is complex, as it manifests with non-specific symptoms which leads to a delay in diagnosis. In most patients, the disease affects the rectosigmoid colon and causes acute-on-chronic persistent abdominal pain and hematochezia, which resembles inflammatory bowel disease (IBD) and ischemic colitis. We wish to share with you 2 recent cases of this disease to increase awareness.

Methods/Interventions: Patient demographics, medical history, presenting symptoms, diagnostic tests, surgical interventions, postoperative outcomes, and histopathology will be discussed.

Results/Outcomes: In case 1, a 67-year-old male with HIV, hypertension, hyperlipidemia presented for evaluation of 1-month of mucoid stools, tenesmus, and weight loss. Initial CT revealed rectosigmoiditis with pericolonic fat stranding. Despite positive E. histolytica testing and metronidazole treatment, symptoms persisted. Subsequent colonoscopy identified pseudomembranes in the sigmoid colon with histopathology suggesting myointimal hyperplasia of mesenteric veins. After persistence of symptoms for 3 months, the patient underwent an urgent Hartman’s procedure. Pathology confirmed IMHMV notable for arterialized veins and vasculitis as shown in Image 1. The patients ostomy was reversed at 6 months and he is doing well. In case 2, a 66-year-old male with hyperlipidemia, hypertension, and gout, presented to the emergency department with 6-week history of abdominal pain, diarrhea, and weight loss. Flexible sigmoidoscopy biopsies indicated ischemic colitis and IMHMV. The patient underwent an urgent Hartman’s procedure, specimen shown in Image 2. Pathology report revealed arteriolized veins within the submucosa, mesentery, and muscularis propria, accompanied by pericolorectal fat necrosis.

Conclusion/Discussion: These cases highlight the diagnostic challenges posed by IMHMV. Careful histopathological examination is crucial in establishing the diagnosis. Key pathological features include cross-sectional imaging demonstrating arterialized veins in the mesentery, pericolorectal fat necrosis, and colonic wall thickening. Identification of these pathological hallmarks may facilitate earlier recognition and prompt surgical management for IMHMV.