Hangeshashinto-Associated Mesenteric Phlebosclerosis and Highly Atypical Adenoma Requiring Laparoscopic Right Hemicolectomy
Mesenteric phlebosclerosis is a rare ischemic colonic disorder caused by impaired venous drainage. Its prevalence is higher in East Asia, where herbal medicine is widely used. Treatment remains controversial. A 76-year-old woman who had taken Hangeshashinto, an herbal medicine, for 11 years was admi...
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MDPI AG
2024-03-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/14/5/565 |
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| author | Ryo Nishiwaki Yasuhiro Inoue Masataka Sugao Natsuko Sugimasa Tetsuya Hamaguchi Midori Noji Kenji Takeuchi Yoshiyuki Ito Toshio Kato Taro Yasuma Corina N. D’Alessandoro-Gabazza Esteban C. Gabazza Ichiro Imoto |
| author_facet | Ryo Nishiwaki Yasuhiro Inoue Masataka Sugao Natsuko Sugimasa Tetsuya Hamaguchi Midori Noji Kenji Takeuchi Yoshiyuki Ito Toshio Kato Taro Yasuma Corina N. D’Alessandoro-Gabazza Esteban C. Gabazza Ichiro Imoto |
| author_sort | Ryo Nishiwaki |
| collection | DOAJ |
| description | Mesenteric phlebosclerosis is a rare ischemic colonic disorder caused by impaired venous drainage. Its prevalence is higher in East Asia, where herbal medicine is widely used. Treatment remains controversial. A 76-year-old woman who had taken Hangeshashinto, an herbal medicine, for 11 years was admitted for endoscopic treatment of high-grade dysplasia in the ascending colon. She had diarrhea and mesenteric phlebosclerosis diagnosed by abdominal computed tomography at age 71. At age 75, small polyps were detected in the ascending colon. A subsequent study revealed an increase in polyp size to 15 mm. Endoscopic mucosal resection failed to remove the lesion. A biopsy showed high-grade dysplasia with possible colon cancer risk. Conservative therapy did not improve mesenteric phlebosclerosis-related diarrhea; therefore, a laparoscopic right hemicolectomy was performed. Intraoperatively, the cecum was adherent to the abdominal wall and the right ovary. The specimen showed high-grade dysplasia in the mucosa and severe submucosal fibrosis. No metastasis was observed. This case shows the link between mesenteric phlebosclerosis and high-grade dysplasia in the ascending colon. Endoscopic mucosal resection was unsuccessful in removing the tumor. Endoscopic submucosal dissection was an alternative, but its safety in mesenteric phlebosclerosis-affected colonic segments remains uncertain. A laparoscopic right hemicolectomy was performed. |
| first_indexed | 2024-04-25T00:32:41Z |
| format | Article |
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| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-04-25T00:32:41Z |
| publishDate | 2024-03-01 |
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| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-dca8d68c6fb04efeb6fb0e2b5683ede12024-03-12T16:42:12ZengMDPI AGDiagnostics2075-44182024-03-0114556510.3390/diagnostics14050565Hangeshashinto-Associated Mesenteric Phlebosclerosis and Highly Atypical Adenoma Requiring Laparoscopic Right HemicolectomyRyo Nishiwaki0Yasuhiro Inoue1Masataka Sugao2Natsuko Sugimasa3Tetsuya Hamaguchi4Midori Noji5Kenji Takeuchi6Yoshiyuki Ito7Toshio Kato8Taro Yasuma9Corina N. D’Alessandoro-Gabazza10Esteban C. Gabazza11Ichiro Imoto12Department of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, JapanDepartment of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, JapanDepartment of Internal Medicine, Doshinkai Tohyama Hospital, Tsu 514-0043, JapanDepartment of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, JapanDepartment of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, JapanDepartment of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, JapanDepartment of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, JapanDepartment of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, JapanDepartment of Surgery, Doshinkai Tohyama Hospital, Tsu 514-0043, JapanDepartment of Immunology, Mie University Faculty and Graduate School of Medicine, Tsu 514-8507, JapanDepartment of Immunology, Mie University Faculty and Graduate School of Medicine, Tsu 514-8507, JapanDepartment of Immunology, Mie University Faculty and Graduate School of Medicine, Tsu 514-8507, JapanDigestive Endoscopy Center, Doshinkai Tohyama Hospital, Tsu 514-0043, JapanMesenteric phlebosclerosis is a rare ischemic colonic disorder caused by impaired venous drainage. Its prevalence is higher in East Asia, where herbal medicine is widely used. Treatment remains controversial. A 76-year-old woman who had taken Hangeshashinto, an herbal medicine, for 11 years was admitted for endoscopic treatment of high-grade dysplasia in the ascending colon. She had diarrhea and mesenteric phlebosclerosis diagnosed by abdominal computed tomography at age 71. At age 75, small polyps were detected in the ascending colon. A subsequent study revealed an increase in polyp size to 15 mm. Endoscopic mucosal resection failed to remove the lesion. A biopsy showed high-grade dysplasia with possible colon cancer risk. Conservative therapy did not improve mesenteric phlebosclerosis-related diarrhea; therefore, a laparoscopic right hemicolectomy was performed. Intraoperatively, the cecum was adherent to the abdominal wall and the right ovary. The specimen showed high-grade dysplasia in the mucosa and severe submucosal fibrosis. No metastasis was observed. This case shows the link between mesenteric phlebosclerosis and high-grade dysplasia in the ascending colon. Endoscopic mucosal resection was unsuccessful in removing the tumor. Endoscopic submucosal dissection was an alternative, but its safety in mesenteric phlebosclerosis-affected colonic segments remains uncertain. A laparoscopic right hemicolectomy was performed.https://www.mdpi.com/2075-4418/14/5/565mesenteric phlebosclerosisHangeshashintoendoscopic mucosal resectionhighly atypical adenoma |
| spellingShingle | Ryo Nishiwaki Yasuhiro Inoue Masataka Sugao Natsuko Sugimasa Tetsuya Hamaguchi Midori Noji Kenji Takeuchi Yoshiyuki Ito Toshio Kato Taro Yasuma Corina N. D’Alessandoro-Gabazza Esteban C. Gabazza Ichiro Imoto Hangeshashinto-Associated Mesenteric Phlebosclerosis and Highly Atypical Adenoma Requiring Laparoscopic Right Hemicolectomy Diagnostics mesenteric phlebosclerosis Hangeshashinto endoscopic mucosal resection highly atypical adenoma |
| title | Hangeshashinto-Associated Mesenteric Phlebosclerosis and Highly Atypical Adenoma Requiring Laparoscopic Right Hemicolectomy |
| title_full | Hangeshashinto-Associated Mesenteric Phlebosclerosis and Highly Atypical Adenoma Requiring Laparoscopic Right Hemicolectomy |
| title_fullStr | Hangeshashinto-Associated Mesenteric Phlebosclerosis and Highly Atypical Adenoma Requiring Laparoscopic Right Hemicolectomy |
| title_full_unstemmed | Hangeshashinto-Associated Mesenteric Phlebosclerosis and Highly Atypical Adenoma Requiring Laparoscopic Right Hemicolectomy |
| title_short | Hangeshashinto-Associated Mesenteric Phlebosclerosis and Highly Atypical Adenoma Requiring Laparoscopic Right Hemicolectomy |
| title_sort | hangeshashinto associated mesenteric phlebosclerosis and highly atypical adenoma requiring laparoscopic right hemicolectomy |
| topic | mesenteric phlebosclerosis Hangeshashinto endoscopic mucosal resection highly atypical adenoma |
| url | https://www.mdpi.com/2075-4418/14/5/565 |
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