Phlebosclerotic colitis
Description
◉ Patient History and Demographics
• Age/Sex: 56-year-old male.
◉ Chief complaints:
• For one day, there was widespread stomach pain.
• Stool passage was absent for a week.
• a week of intermittent nausea and vomiting.
• Previous health history:
• For two years, hypertension was effectively managed with medication.
◉ Relevant history:
• For more than 30 years, a Chinese herbal syrup and alcohol have been regularly consumed to treat sporadic stomach ache.
• Three years prior, a similar bout of widespread abdominal pain was treated conservatively following imaging; surgery was not done at that time.
• Ethics: Shin Kong Wu Ho-Su Memorial Hospital in Taipei, Taiwan's Institutional Review Board gave its approval to the study.
• Written informed consent was acquired.
◉ Physical Assessment
• Vital signs: stable, with no reports of fever or hypotension.
• Findings in the abdomen:
• Indications of localized peritoneal irritation include rebound discomfort over the right upper quadrant.
• There was no initial description of any felt bulk or distension.
• General examination: No signs of dehydration, anemia, or jaundice were noted.
◉ Research in the Lab
• First findings:
• Mild leukocytosis: 12,600 WBCs/μl.
• 70.1% are neutrophils.
• Electrolyte profiles and biochemistry: within typical bounds.
◉ progress:
• WBC count later increased to 18,800/μl.
• A growing ischemia or inflammatory process was indicated by the 88% increase in neutrophils.
◉ Pathological Analysis
• Gross pathology:
• The colon has several hemorrhagic patches and a dark purple mucosal discolouration.
• The right colon has the most significant mural thickening.
• At the hepatic flexure, segmental stenosis was seen.
◉ Microscopic observations:
• ulcerations, erosions, and necrosis of the mucosa.
• Submucosa: Infiltrations of inflammation, edema, and hemorrhage.
◉ Vessels:
• many venules and sclerotic veins that exhibit ossification, calcification, and hyalinization.
• thrombosis and in some places, almost complete blockage of venous lumens.
• Both intramural and extramural veins were altered.
• No perforation was found.
◉ Radiological Characteristics
• Numerous tiny, thread-like, or serpentine calcifications in the colonic region, frequently perpendicular to the colon's long axis, are visible on radiographs.
• CT scan:
• Serpentine calcifications of the intramural and mesenteric veins are a diagnostic hallmark.
• linked to inadequate contrast enhancement, luminal stenosis, mural thickness, and occasionally ascites.
• The dispersion of superior mesenteric vein (SMV) branches is frequently followed by calcifications.
◉ Overview of the Disease and Discussion
• PC, or phlebosclerotic colitis:
• Definition: A rare ischemic colitis brought on by calcification, fibrosis, and persistent mesenteric venous sclerosis that impairs venous drainage.
• Geographic distribution: Predominantly reported in East Asian countries (Japan, Taiwan, Hong Kong, Korea).
• Both genders are affected, and the median age is around 59.
• Predilection site: Most frequently affected is the right-sided colon (cecum and ascending colon), while it can also spread to the transverse and descending colon.
◉ Clinical Features
• Symptoms: Chronic and nonspecific.
• Pain in the abdomen (most common).
• either constipation or diarrhea.
• vomiting, ileus, or nausea.
• Positive occult blood or occasional bloody stools.
• Stricture may cause intestinal blockage in certain patients.
◉ Physical findings:
• Usually modest, although in cases of substantial intestinal thickening, there may be palpable mass or localized pain.
• Numerous tiny, thread-like, or serpentine calcifications in the colonic region, frequently perpendicular to the colon's long axis, are visible on radiographs.
◉ CT scan:
• Serpentine calcifications of the intramural and mesenteric veins are a diagnostic hallmark.
• linked to inadequate contrast enhancement, luminal stenosis, mural thickness, and occasionally ascites.
• The dispersion of superior mesenteric vein (SMV) branches is frequently followed by calcifications.
◉ Angiography:
• SMA patent, but decreased vascularity and venous flow during the venous phase.
• Pathogenesis (Suggested Mechanisms) 12.
• Uncertain cause, but a number of theories:
• Prolonged exposure to pollutants causes venous endothelium degradation, which leads to calcification, sclerosis, and fibrosis.
• Predominance of the right colon: Perhaps because of:
• extended toxic agent stasis in RT In the ascending colon, water-soluble irritants are preferentially absorbed CLN.
• Increased intraluminal pressure on the right side
• Persistent venous blockage → hypoxia → secondary mucosal damage and fibrosis is the hallmark of chronic low-grade ischemia.
Protocol
◉ Management and Treatment Strategy
The severity of the disease determines the approach:
Early or mild stage:
Conservative treatment includes fluids, bowel rest, and, if necessary, antibiotics.
routine colonoscopic monitoring and imaging.
avoiding poisonous or herbal compounds.
Complex or advanced stage:
If there is ischemia, necrosis, or intestinal blockage, surgery is necessary.
Depending on the extent, procedures can involve a right hemicolectomy, subtotal colectomy, or total colectomy.
Surgical results are generally positive; most of the time, surgery is curative.
Postoperative follow-up: Extended observation for problems or recurrence.
◉ Difficulties with Phlebosclerotic Colitis:
• Initial symptoms that are not specific: Early diagnosis is challenging since patients may appear with bloody stools, diarrhea, ileus, or minor stomach pain.
• Severe disease progression: The illness usually necessitates emergency care when it progresses to gangrene, ischemic alterations, acute abdominal pain, or intestinal blockage.
• Delays in diagnosis: Serpentine vascular calcifications on CT are a key radiologic characteristic that are frequently overlooked in the early stages, which delays therapy.
• Chronic symptoms: Intermittent bowel dysfunction and recurrent stomach pain might lower quality of life.
Progressive venous calcification, wall thickening, luminal stenosis, necrosis, ulceration, bleeding, and potential intestinal perforation are examples of potential side effects.
• Health Care Administration:
• Mild or early illness stages: When there is no intestinal compromise (such as peritonitis or severe ischemia), conservative treatment is recommended.
• Observation and supportive care: Keep an eye on laboratory results (e.g., leukocytosis, renal function), bowel function, vital signs, and fluid and electrolyte balance.
• Pharmacologic therapy includes antibiotics for suspected infections, antiemetics for nausea and vomiting, and analgesics for pain management.
• Dietary changes include avoiding irritating foods or herbal chemicals linked to the condition, restoring oral intake gradually after recovery, and resting the bowel.
• Monitoring: Repeat imaging (abdominal radiography, CT scan) to monitor progress.
• Advanced or severe disease (with intestinal compromise): Ischemia, necrosis, or gangrene necessitate surgery.
• Affected colon segments are removed during an emergency subtotal or total colectomy, as was done in the case that was reported.
• Postoperative care includes close observation, infection control, wound care, and assistance with dietary requirements.
• Comprehensive Evaluation and Monitoring of Nursing Interventions
• regular observation of bowel movements, distension, tenderness, and abdominal pain.
• Check vital signs for signs of acute abdomen or peritonitis, as well as instability (tachycardia, hypotension, fever).
• Keep an eye on lab values such the white blood cell count, electrolytes, renal function, and sepsis symptoms.
• Check for alterations in hemodynamic stability, output, and mental state.
Notes
For more details visit: https://pmc.ncbi.nlm.nih.gov/articles/PMC3919902/
