Idiopathic mesenteric phlebosclerosis initially misdiagnosed as bowel obstruction: a case report

Idiopathic Mesenteric Phlebosclerosis is a rare and misdiagnosed gastrointestinal condition marked by mesenteric venous sclerosis and calcification, which can lead to chronic mesenteric ischemia and colonic irregularities. This study reports a 68-year-old male with recurrent abdominal bloating and constipation, initially misdiagnosed as intestinal obstruction. The medical history of the patient included prolonged use of Gardenia Jinhua Wan, a herbal preparation containing Gardenia. Imaging studies, including CT scans, revealed calcified mesenteric veins and colonic wall thickening, while colonoscopy indicated deep blue mucosa with ulcerations and stricture, which are the characteristic features of IMP. Histopathological analysis validated chronic inflammation and submucosal fibrosis, and Masson trichrome-positive staining ruled out amyloidosis (Congo red-negative). The IMP diagnosis was confirmed after the discontinuation of the herbal remedy, while mesalazine and aspirin significantly alleviated symptoms. This case highlights the importance of considering IMP as the differential diagnosis of chronic gastrointestinal problems, particularly when associated with the use of herbal medicine. These findings suggest that early identification and imaging results, including venous calcifications and endoscopic mucosal discolouration, are crucial for preventing misinterpretation and unwarranted interventions.