Idiopathic myointimal hyperplasia of mesenteric veins, an inflammatory bowel diseaselike condition: A case and review of the literature

Wei Wang¹Xue Deng^1,2Yue Zhang^1,2Mengxue Yang¹Xin Jiang²Xuefeng Tang^2*

• ¹Chongqing Medical University, Chongqing, China
• ²Chongqing General Hospital, Chongqing, China

Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is a rare and poorly understood disease that occurs in the rectosigmoid colon of predominantly young, previously healthy, male patients. This disease is often confused with inflammatory bowel disease clinically , exhibiting showing ischemic mucosal changes without the classic features of inflammatory bowel disease on biopsy. Surgical resection of the diseased bowel segment reveals the true etiology of the pathology and is curative. The etiology of IMHMV remains unclear. We describe the case of a female patient with IMHMV at the right hemicolon, concomitant with Clostridium difficile infection, whose management for C. difficile infection failed to resolve her symptoms. The patient underwent a laparoscopic right hemicolectomy with pathology showing mesenteric vein occlusion owing to myointimal hyperplasia, as confirmed by elastin and desmin stain. Histopathological examination confirmed the diagnosis of IMHMV. The patient was followed up postoperatively in good condition, with no recurrence observed. This is the first reported case of IMHMV in the right hemicolon, concomitant with Clostridium difficile infection. In this case report, we present data on 82 reported cases of IMHMV from 1991 to 2024, focusing on the clinical, imaging, and pathological characteristics. It is crucial for a better understanding of the disease, prevention of unnecessary pharmacotherapy, and reduction in diagnostic delay.