Idiopathic Mesenteric Phlebosclerosis

CASE REPORT A 78-year-old man was admitted with persistent constipation associated with low back pain for 3 months. His medical history was notable for the prolonged intake of herbal preparations containing Gardenia jasminoides. Contrast-enhanced computed tomography imaging of the abdomen revealed diffuse thickening of the ascending and transverse colonic walls (Figure 1). It also demonstrated the characteristic “comb-like” sign,1 resulting from extensive calcifications of the superior mesenteric vein and its tributaries within the pericolonic mesentery (Figure 2). The affected colon wall showed mild enhancement, which was less pronounced than that of the normal bowel wall. The pericolonic fat plane was obscured. These findings supported the diagnosis of idiopathic mesenteric phlebosclerosis.2 Idiopathic mesenteric phlebosclerosis is an uncommon colonic ischemia predominantly documented in East Asia.3 Prolonged consumption of herbal formulas containing geniposide is postulated to be a potential contributing factor.4 The condition lacks typical clinical symptoms, often leading to missed or misdiagnosis.5 Therefore, recognizing characteristic imaging signs such as diffuse thickening of the right colon and the “comb-like” sign is crucial for the diagnosis in patients with a relevant herbal history. The patient improved symptoms with conservative management.Figure 1.: Sagittal contrast-enhanced computed tomography (CT) image shows diffuse thickening of the colon wall and calcifications of the surrounding mesenteric veins.Figure 2.: (A) and (B) Maximum intensity projection image shows multiple calcifications in the branches of the superior mesenteric vein, conforming to the classic “comb-like” appearance.DISCLOSURES Author contributions: Z. Yan: conceptualization, data curation, analysis, methodology, and writing the original draft. Z. Yan and X. He: review and editing of the manuscript. Financial disclosure: The Luzhou Science and Technology Bureau (Grant No. 2024LZXNYDJ059). Informed consent was obtained for this case report. All data generated or analyzed during this study are included in this published article and its supplementary information files.