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Matsuda K, Hashiguchi Y, Kikuchi Y, Asako K, Ohno K, Okada Y, Yagi T, Tsukamoto M, Fukushima Y, Shimada R, Ozawa T, Hayama T, Tsuchiya T, Nozawa K, Sasajima Y, Kondo F. Successful surgical management of mesenteric inflammatory veno-occlusive disease. Surg Case Rep 2020; 6:27. [PMID: 31965458 PMCID: PMC6973805 DOI: 10.1186/s40792-020-0796-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The term "mesenteric inflammatory veno-occlusive disease (MIVOD)" is used to describe an ischemic injury resulting from phlebitis or venulitis that affects the bowel or mesentery in the absence of arteritis. MIVOD is difficult to diagnose because of its rarity and frequent confusion with other diseases. The incidence and etiology of MIVOD remain unclear; only a few cases have been reported. We describe a case of the successful surgical management of a patient with MIVOD with characteristic images. CASE PRESENTATION A 65-year-old Japanese man visited a hospital with the chief complaint of abdominal pain in January 2018. CT showed edema and thickening of the intestinal wall from the descending colon to the rectum. The patient was admitted to the hospital. Suspected diagnoses were enteritis, ulcerative colitis, amyloidosis, vasculitis, malignant lymphoma, and venous thrombus, but no definitive diagnosis was obtained. The patient was transferred to our hospital for the treatment of stenosis (located from the descending colon to the rectum) and bowel obstruction. An emergency transverse colostomy was performed. The sigmoid colon and mesentery were too rigid and edematous to resect. Colonic hemorrhage occurred 2 weeks after the surgery. With radiology intervention, coiling for the arteriovenous fistula in the descending colon was performed, and hemostasis was obtained. A colonoscopy at 6 months post-surgery showed neither ulceration nor stenosis in the rectum, indicating that the rectum could be preserved in the next surgery. However, severe stenosis in the descending and sigmoid colon remained unchanged. Ten months after the transverse colostomy, we performed a subtotal colectomy and ileorectal anastomosis, and an ileostomy was created. The sigmoid colon and mesentery were not so rigid compared to the first surgery's findings, and we were able to resect intestine and mesentery. Histopathology revealed phlebitis and venulitis, fibrinoid necrosis, and normal arteries, meeting the diagnostic criteria for MIVOD. Postoperatively, the patient showed no recurrence for 8 months. CONCLUSION Clinicians should consider MIVOD when examining a patient with intestinal ischemia. When MIVOD is suspected, the patient is indicated for surgery based on an accurate diagnosis and good prognosis.
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Affiliation(s)
- Keiji Matsuda
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yoshinao Kikuchi
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Asako
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Kohei Ohno
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yuka Okada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Takahiro Yagi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Mitsuo Tsukamoto
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yoshihisa Fukushima
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Ryu Shimada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Tsuyoshi Ozawa
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Tamuro Hayama
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Takeshi Tsuchiya
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Keijiro Nozawa
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yuko Sasajima
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Fukuo Kondo
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
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Yamada Y, Sugimoto K, Yoshizawa Y, Arai Y, Otsuki Y, Arai T, Kobayashi Y, Sato Y, Hosoda Y. Mesenteric inflammatory veno-occlusive disease occurring during the course of ulcerative colitis: a case report. BMC Gastroenterol 2018; 18:9. [PMID: 29325532 PMCID: PMC5765608 DOI: 10.1186/s12876-018-0737-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/02/2018] [Indexed: 12/17/2022] Open
Abstract
Background Mesenteric inflammatory veno-occlusive disease (MIVOD) is difficult to diagnose because of its rarity, nonspecific clinical findings, and frequent confusion with other diseases including inflammatory bowel disease. This report presents a very rare case of MIVOD that occurred during the course of ulcerative colitis (UC). Case presentation A 32-year-old man, who had been diagnosed with UC at the age of 29 and was in remission maintained by oral administration of 5-aminosalicylic acid (5-ASA), showed exacerbation of diarrhea and was admitted to the hospital. Since it was deemed an exacerbation of UC, intravenous steroid therapy and oral administration of tacrolimus were initiated, but his condition continued to worsen. Abdominal computed tomography (CT) was performed and showed intraperitoneal free air, leading to a diagnosis of gastrointestinal perforation and the performance of emergency surgery (subtotal colectomy and ileostomy). Histopathological examination of the resected colon of the patient showed mucosal inflammatory findings that were not typical of UC, including multiple organized thrombi with recanalization in the veins existing in the submucosal layer to the subserosal layer and an increased infiltration of inflammatory cells. These findings led to the pathological diagnosis of MIVOD. Conclusion We report a very rare case in which MIVOD occurred during the course of UC.
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Affiliation(s)
- Yosuke Yamada
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Ken Sugimoto
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
| | - Yashiro Yoshizawa
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Yoshifumi Arai
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, 173-0015, Japan
| | - Yasuyuki Kobayashi
- Department of Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Yoshihiko Sato
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Yoshisuke Hosoda
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
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3
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Miracle AC, Behr SC, Benhamida J, Gill RM, Yeh BC. Mesenteric inflammatory veno-occlusive disease: radiographic and histopathologic evaluation of 2 cases. ACTA ACUST UNITED AC 2015; 39:18-24. [PMID: 24318211 DOI: 10.1007/s00261-013-0049-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mesenteric inflammatory veno-occlusive disease (MIVOD) is a rare cause of inflammatory enterocolitis whose clinical and imaging presentation can be confused with mesenteric venous thrombosis and inflammatory bowel disease. We report two cases of histologically proven MIVOD in patients presenting with abdominal pain and describe potentially useful distinguishing features at contrast-enhanced CT, including prominent small pericolonic arteries and veins but a diminutive or absent inferior mesenteric vein. Alerting referring clinicians to the possibility of this diagnosis may help avoid unnecessary anticoagulation and reduce diagnostic delay. Treatment of MIVOD is surgical resection, which is typically curative.
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Affiliation(s)
- Aaron C Miracle
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA, 94143-0628, USA,
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Ayres LRO, Scott M, Shepherd N, Brown J. An unusual case of mesenteric ischaemia. Frontline Gastroenterol 2014; 5:36-39. [PMID: 28839748 PMCID: PMC5369707 DOI: 10.1136/flgastro-2013-100369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 08/26/2013] [Accepted: 08/29/2013] [Indexed: 02/04/2023] Open
Abstract
We describe an unusual cause of diarrhoea and segmental colitis in a previous well adult man. Mesenteric inflammatory veno-occlusive disease is a rare cause of gastrointestinal tract ischaemia of unknown aetiology. We review the literature of this condition and other mesenteric venous pathologies.
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Affiliation(s)
- L R O Ayres
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK,Department of Gastroenterology, Fremantle Hospital, Western Australia,Australia
| | - M Scott
- Department of Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - N Shepherd
- Department of Pathology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - J Brown
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
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5
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Cervera R, Espinosa G. Unusual manifestations of the antiphospholipid syndrome. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ijr.09.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Antiphospholipid syndrome (APS) is primarily considered to be an autoimmune pathological condition that is also referred to as "Hughes syndrome". It is characterized by arterial and/or venous thrombosis and pregnancy pathologies in the presence of anticardiolipin antibodies and/or lupus anticoagulant. APS can occur either as a primary disease or secondary to a connective tissue disorder, most frequently systemic lupus erythematosus (SLE). Damage to the nervous system is one of the most prominent clinical constellations of sequelae in APS and includes (i) arterial/ venous thrombotic events, (ii) psychiatric features and (iii) other non- thrombotic neurological syndromes. In this overview we compare the most important vascular ischemic (occlusive) disturbances (VIOD) with neuro-psychiatric symptomatics, together with complete, updated classifications and hypotheses for the etio-pathogenesis of APS with underlying clinical and laboratory criteria for optimal diagnosis and disease management.
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Affiliation(s)
- Penka A Atanassova
- Department of Neurology, Medical University, 15A V. Aprilov Blvd., Plovdiv, 4000, Bulgaria.
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7
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Cervera R, Espinosa G, Cordero A, Oltra MR, Unzurrunzaga A, Rossiñol T, Plaza J, Bucciarelli S, Ramos-Casals M, Ingelmo M, Asherson RA, Font J. Intestinal involvement secondary to the antiphospholipid syndrome (APS): clinical and immunologic characteristics of 97 patients: comparison of classic and catastrophic APS. Semin Arthritis Rheum 2007; 36:287-96. [PMID: 17207521 DOI: 10.1016/j.semarthrit.2006.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 09/08/2006] [Accepted: 09/25/2006] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To analyze the clinical and laboratory characteristics of 97 patients with intestinal involvement secondary to the antiphospholipid syndrome (APS) (37 patients with classic APS and 60 with catastrophic APS). METHODS A computer-assisted (PubMed) search of the literature was performed to identify all cases of intestinal involvement associated with the APS from 1983 to December 2005. In addition, we analyzed the web-site-based international registry of patients with catastrophic APS ("CAPS Registry"). RESULTS There were no differences in distribution by gender, mean age, and previous clinical manifestations of APS between the 2 groups. The prevalence of abdominal pain as the presenting manifestation of intestinal ischemia was higher in patients with classic APS (76% versus 37%; P < 0.005). The main difference in histopathologic findings between the 2 groups was the higher rate of microthrombosis in patients with catastrophic APS (75% versus 4%; P < 0.0005). The mortality rate was higher in patients with catastrophic APS (55% versus 17%; P < 0.0005). Follow-up was available in 22 patients with classical APS: 17 of them were discharged on oral anticoagulation and with a mean follow-up of 13 months (range, 1 to 48); all were in good health without the development of new thrombotic events. CONCLUSIONS Intestinal involvement, although infrequent, is an important complication in patients with APS, especially in those with catastrophic APS. This would support the need for systematic screening for aPL in all cases of mesenteric thrombosis or ischemic colitis without clear underlying predisposing factors, and for systematic screening procedures in all classic APS patients complaining of abdominal pain.
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Affiliation(s)
- Ricard Cervera
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.
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8
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Ben Ghorbel I, Ibn Elhadj Z, Miled M, Houman MH. Le syndrome primaire des anticorps antiphospholipides : une cause rare de thrombose veineuse mésentérique. À propos de deux observations. Rev Med Interne 2006; 27:637-9. [PMID: 16777270 DOI: 10.1016/j.revmed.2006.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 03/21/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The antiphospholipid syndrome had been rarely reported as a cause of mesenteric venous thrombosis. CASE REPORT We report two exceptional cases of primary antiphospholipid syndrome associated with mesenteric venous thrombosis in 51 years old man and 27 years old women. DISCUSSION Identifying the underlying process is very important to try to propose a specific treatment.
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Affiliation(s)
- I Ben Ghorbel
- Service de médecine interne, hôpital La-Rabta. 1007 Tunis, Tunisie.
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9
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Jara LJ, Medina G, Vera-Lastra O, Barile L. The impact of gender on clinical manifestations of primary antiphospholipid syndrome. Lupus 2006; 14:607-12. [PMID: 16175932 DOI: 10.1191/0961203305lu2176oa] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objective of the study was to determine the clinical differences at diagnosis and during follow-up between male and female patients with primary antiphospholipid syndrome (PAPS). We analysed 68 patients, 30 males and 38 females diagnosed and followed between 1990 and 2003. Patients with antiphospholipid syndrome associated with systemic lupus erythematosus at onset and during follow-up were excluded. The mean age at diagnosis was 31.4 +/- 11 years in males and 35.7 +/- 11 years in females (NS). The follow-up after diagnosis was 8.7 +/- 3.1 years in males and 9.2 +/- 2.9 years in females (NS). We did not find significant differences between the two groups with respect to venous and arterial thrombosis. However, in female patients, stroke was more prevalent than in male patients (12/38 versus 3/30, P = 0.03). In contrast, we found a significant prevalence of severe gastrointestinal complications in male compared to female patients (7/30 versus 1/38, P = 0.009). One male patient died due to catastrophic antiphospholipid syndrome. This study suggests that clinical course in patients with PAPS may be different with significant prevalence of central nervous system involvement in females and gastrointestinal involvement in males. Factors such as accelerated atherosclerosis, hormones, related to gender could be the explanation of these findings.
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Affiliation(s)
- L J Jara
- Research Division, Hospital de Especialidades Centro Médico la Raza, Mexico city, Mexico.
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10
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Hu JCC, Forshaw MJ, Thebe P, Stewart M. Mesenteric Inflammatory Veno-occlusive Disease as a Cause of Acute Abdomen: Report of Five Cases. Surg Today 2005; 35:961-4. [PMID: 16249852 DOI: 10.1007/s00595-004-3036-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 11/16/2004] [Indexed: 11/25/2022]
Abstract
Mesenteric inflammatory veno-occlusive disease (MIVOD) is a rare but increasingly recognized cause of intestinal ischemia. It can be defined as phlebitis or venulitis affecting either the bowel or mesentery, without any evidence of coexisting arterial inflammatory involvement or an obvious predisposing cause. We report the clinicopathological characteristics of five patients who, after presenting with an acute abdomen, underwent exploratory laparotomy and resection of ischemic bowel. The distinctive histopathological characteristics of MIVOD were identified in all five patients. We review the literature on this under-reported condition.
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Affiliation(s)
- Jennifer C C Hu
- Department of Surgery, Darent Valley Hospital, Dartford, Kent, UK
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11
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Abstract
Mesenteric inflammatory veno-occlusive disease (MIVOD) is a clinicopathological entity recently described for a case series of patients with intestinal ischemia of unknown etiology. MIVOD is characterized as a venulitis with lymphocytic, necrotizing, or mixed granulomatous morphology. The disease seems to be self-limiting with resolution of symptoms after surgical resection. We describe a 71-year-old man who developed focal intestinal ischemia in the postoperative period after laparoscopic appendectomy. At re-exploration, a 20-cm segment of grossly ischemic jejunum was identified and resected. The excised specimen demonstrated early ischemic mucosal injury and necrotizing mesenteric venulitis with thrombosis, consistent with verso-occlusive disease. The etiology of this rare vasculitis is currently unknown. We present our case report, which is followed by a review of the literature of MIVOD.
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Affiliation(s)
| | - Jeff Smith
- Orlando Regional Healthcare, Orlando, Florida
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12
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Wright CL, Cacala S. Enterocolic lymphocytic phlebitis with lymphocytic colitis, lymphocytic appendicitis, and lymphocytic enteritis. Am J Surg Pathol 2004; 28:542-7. [PMID: 15087675 DOI: 10.1097/00000478-200404000-00015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe a 53-year-old man with a history of diarrhea temporally related to the use of flutamide. He developed an acute abdomen, and presented with an ileocecal intussusception due to an edematous ischemic cecum. The ischemia was due to enterocolic lymphocytic phlebitis (ELP), with numerous associated thrombi. The phlebitis involved not only the ischemic area but also the grossly unaffected areas, including the entire right colon, terminal ileum, and appendix. All layers of the bowel wall were involved. Mesenteric veins were also prominently affected, but the arteries were spared. This rare form of vasculitis was associated with a marked lymphocytic infiltrate involving the epithelium of the entire right colon, ileum, and appendix. This is the first reported case of ELP occurring in conjunction with lymphocytic colitis, lymphocytic enteritis, and lymphocytic appendicitis. The temporal association of the patient's symptoms with flutamide use suggests that this peculiar form of lymphocytic inflammation of the veins and mucosa likely represents a drug reaction. We suggest that some cases of lymphocytic colitis may also be associated with ELP but are unlikely to be recognized unless affected submucosal vessels happen to be included in the biopsy.
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Affiliation(s)
- Cheryl L Wright
- Surgical Pathology Unit, North Shore Hospital, Takapuna, Auckland, New Zealand.
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13
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Asherson RA, Cervera R. Unusual manifestations of the antiphospholipid syndrome. Clin Rev Allergy Immunol 2003. [PMID: 12794262 DOI: 10.1385/criai] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The classical clinical picture of the antiphospholipid syndrome (APS) is characterized by venous and arterial thromboses, fetal losses and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or antibodies to the protein "cofactor" b2 glycoprotein I. Single vessel involvement or multiple vascular occlusions may give rise to a wide variety of presentations. Any combination of vascular occlusive events may occur in the same individual and the time interval between them also varies considerably from weeks to months or even years. Deep vein thrombosis, sometimes accompanied by pulmonary embolism, is the most frequently reported manifestation in this syndrome. Cerebrovascular accidents-either stroke or transient ischemic attacks-are the most common arterial thrombotic manifestations. Early and late fetal losses, premature births and pre-eclampsia are the most frequent fetal and obstetric manifestations. Additionally, several other clinical features are relatively common in these patients, i.e., thrombocytopenia, livedo reticularis, heart valve lesions, hemolytic anemia, epilepsy, myocardial infarction, leg ulcers, and amaurosis fugax. However, a large variety of other clinical manifestations have been less frequently described in patients with the APS, with prevalences lower than 5%. These include, among others, large peripheral or aortic artery occlusions, Sneddon's syndrome, chorea, transverse myelopathy, intracardiac thrombus, adult respiratory distress syndrome, renal thrombotic microangiopathy, Addison's syndrome, Budd-Chiari syndrome, nodular regenerative hyperplasia of the liver, avascular necrosis of the bone, cutaneous necrosis or subungual splinter hemorrhages. In this article, some of these "unusual" manifestations are reviewed.
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Affiliation(s)
- Ronald A Asherson
- Rheumatic Diseases Unit, Department of Medicine, University of Cape Town School of Medicine, Cape Town, South Africa
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14
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Bando H, Kobayashi S, Matsumoto T, Tamura N, Yamanaka K, Yamaji C, Takasaki C, Takasaki Y, Hashimoto H. Acute acalculous cholecystitis induced by mesenteric inflammatory veno-occlusive disease (MIVOD) in systemic lupus erythematosus. Clin Rheumatol 2003; 22:447-9. [PMID: 14677025 DOI: 10.1007/s10067-003-0766-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2002] [Accepted: 05/22/2003] [Indexed: 12/01/2022]
Abstract
A 43-year-old woman with systemic lupus erythematosus (SLE) was treated for lupus pleurisy. During the course of her illness, she abruptly suffered severe right hypochondriac pain and high-grade fever. Abdominal ultrasonography revealed a thickening of the gallbladder wall without cholelithiasis, and she was diagnosed with acute acalculous cholecystitis (AAC). Laparoscopic cholecystostomy was performed. Pathological examination revealed lymphocytic venulitis without arteritis. Antiphospholipid antibodies were not demonstrated during the course of illness. From these findings, the cause of AAC was revealed as a mesenteric inflammatory veno-occlusive disease (MIVOD), which is a novel venopathy mainly affecting the mesenteric vein and/or its branches, causing serious ischemic complications. MIVOD should be considered as a possible cause of AAC.
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Affiliation(s)
- Hideaki Bando
- School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-Ku, 113-8421 Tokyo, Japan.
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15
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Abstract
The classical clinical picture of the antiphospholipid syndrome (APS) is characterized by venous and arterial thromboses, fetal losses and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or antibodies to the protein "cofactor" b2 glycoprotein I. Single vessel involvement or multiple vascular occlusions may give rise to a wide variety of presentations. Any combination of vascular occlusive events may occur in the same individual and the time interval between them also varies considerably from weeks to months or even years. Deep vein thrombosis, sometimes accompanied by pulmonary embolism, is the most frequently reported manifestation in this syndrome. Cerebrovascular accidents-either stroke or transient ischemic attacks-are the most common arterial thrombotic manifestations. Early and late fetal losses, premature births and pre-eclampsia are the most frequent fetal and obstetric manifestations. Additionally, several other clinical features are relatively common in these patients, i.e., thrombocytopenia, livedo reticularis, heart valve lesions, hemolytic anemia, epilepsy, myocardial infarction, leg ulcers, and amaurosis fugax. However, a large variety of other clinical manifestations have been less frequently described in patients with the APS, with prevalences lower than 5%. These include, among others, large peripheral or aortic artery occlusions, Sneddon's syndrome, chorea, transverse myelopathy, intracardiac thrombus, adult respiratory distress syndrome, renal thrombotic microangiopathy, Addison's syndrome, Budd-Chiari syndrome, nodular regenerative hyperplasia of the liver, avascular necrosis of the bone, cutaneous necrosis or subungual splinter hemorrhages. In this article, some of these "unusual" manifestations are reviewed.
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Affiliation(s)
- Ronald A. Asherson
- Rheumatic Diseases Unit, Department of Medicine, University of Cape Town School of Medicine, Cape Town, South Africa
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
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16
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Cappell MS. Intestinal (mesenteric) vasculopathy. I. Acute superior mesenteric arteriopathy and venopathy. Gastroenterol Clin North Am 1998; 27:783-825, vi. [PMID: 9890114 DOI: 10.1016/s0889-8553(05)70033-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Intestinal vasculopathy is not rare, comprising about 1 per 1000 hospital admissions. Primary mesenteric vasculopathy causes cardiovascular disease, whereas secondary mesenteric ischemia causes extrinsic vascular compression or vascular trauma. Acute superior mesenteric arteriopathy is caused by a mesenteric embolus, thrombus, or vasospasm (i.e., nonocclusive vasculopathy). Acute superior mesenteric venopathy is caused by a thrombus, which is often associated with a hypercoagulopathy. The clinical presentation of both diseases is often subtle and nonspecific at an early stage and becomes overt and specific only when advanced and severe, when ischemia progresses to necrosis. The mortality of acute superior mesenteric arteriopathy is still very high, whereas superior mesenteric venopathy is less rapidly progressive and has a lower, but still significant, mortality. Early diagnosis and aggressive therapy significantly reduces the mortality of these life-threatening diseases.
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Affiliation(s)
- M S Cappell
- Division of Gastroenterology, Maimonides Medical Center, New York State Health Science Center, Brooklyn, New York, USA
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17
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Cappell MS. Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia. Gastroenterol Clin North Am 1998; 27:827-60, vi. [PMID: 9890115 DOI: 10.1016/s0889-8553(05)70034-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ischemic colitis accounts for approximately half of all cases of mesenteric vasculopathy. The clinical presentation varies depending on underlying cause, extent of vascular obstruction, rapidity of ischemic insult, degree of collateral circulation, and presence of comorbidity. Ischemic colitis is usually diagnosed by colonoscopy. Only approximately 20% of patients require surgery because of signs or laboratory findings of peritonitis or because of clinical deterioration. Approximately 20% of patients develop chronic colitis from irreversible colonic ischemic injury, which manifests clinically as persistent diarrhea, rectal bleeding, or weight loss and endoscopically as a colonic stricture or mass. Chronic mesenteric ischemia is almost always caused by significant atherosclerotic stenosis involving at least two mesenteric arteries, usually the superior mesenteric artery and celiac axis. The classic symptomatic triad of postprandial pain, fear of eating, and involuntary weight loss occurs with advanced disease.
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Affiliation(s)
- M S Cappell
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
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Swiader L, Disdier P, Aillaud MF, Christides C, Veit V, Chagnaud C, Harlé JR, Weiller PJ. [Perihepatitis and strong lupus anticoagulant. Apropos of a case]. Rev Med Interne 1997; 18:584-5. [PMID: 9255380 DOI: 10.1016/s0248-8663(97)80814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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