Clinical manifestations and imaging features of inferior mesenteric vein-related colon ischemia

Table 1 Clinical data from 11 patients with inferior mesenteric vein-related conditions

No.	Sex	Age	Disease duration	Chief complaint	Complication	Comorbidity	Endoscopic appearance	Abnormal vessels	Etiology	Treatment	Prognosis
1	Male	62	5 months	Defecation difficulty, abdominal pain	Incomplete intestinal obstruction	PE, DVT; HBP; DM	Involvement of left colon and proximal rectum; multifocal lesions; congestion, edema, fragileness, ecchymosis, patchy erythema, erosion, ulceration, and stricture	IMV	Thrombosis, thrombophilia	Liquid diet, anticoagulation	Symptoms initially improved, but then worsened again, leading to surgery
2	Male	38	9 months	Abdominal pain with mucous bloody stools	Sigmoid colon perforation	PE; portal vein cavernous transformation	Not reach the cecum; involvement of left colon and entire rectum; multifocal lesions; congestion, edema, fragileness, patchy erythema, erosion, ulceration and stricture	SMV, IMV, PV	Thrombosis, thrombophilia	Liquid diet, prednisone, antibiotics	At the onset, inflammatory bowel disease with infection was considered, followed by surgery due to gastrointestinal perforation
3	Male	65	7 months	Diarrhea	None	CHD; DM	Not reach the cecum; involvement of both left and right colon, entire rectum; multifocal lesions; congestion, edema, patchy erythema and stricture	SMV, IMV, PV	Thrombosis	Anticoagulation	Surgery due to poor therapeutic effect
4	Male	63	5 years	Diarrhea	None	Portal vein cavernous transformation with parietal thrombus formation; dilatation of the small intestinal lymphangion	Involvement of entire colon and rectum; multifocal lesions; congestion, edema, and patchy erythema	SMV, IMV, PV	Abdominal tuberculosis	MCT diet; anticoagulation	Partial relief of symptoms
5	Male	60	2 years	Diarrhea	Protein-losing enteropathy	HBP	Not reach the cecum; involvement of left colon and entire rectum; multifocal lesions; congestion, edema, patchy erythema and erosion	IMV	Thrombosis	Liquid diet, anticoagulation, vasodilators	Surgery due to poor therapeutic effect
6	Male	36	5 months	Abdominal pain, mucous bloody stools	Incomplete intestinal obstruction	HBP; acute lymphocytic leukemia treated by allogeneic hematopoietic stem cell transplantation	Not reach the cecum; involvement of left colon and entire rectum; multifocal lesions; congestion, edema, fragileness, patchy erythema, erosion, ulceration and stricture	IMV	Thrombotic microangiopathy	Fasting, anticoagulation, vasodilators	Relief of symptoms
7	Male	69	8 months	Abdominal pain, diarrhea	None	Portal vein cavernous transformation; HBP	Not reach the cecum; involvement of left colon and entire rectum; multifocal lesions; congestion, edema, fragileness, patchy erythema, erosion, and stricture	IMV, PV	Thrombotic microangiopathy	Liquid diet, anticoagulation	Surgery due to poor therapeutic effect
8	Male	72	8 months	Abdominal pain, flatulence and reduced defecation	Incomplete intestinal obstruction	None	Not reach the cecum; involvement of left colon and entire rectum; multifocal lesions; congestion, edema, fragileness, patchy erythema, erosion, and stricture	IMV	Thrombosis	Liquid diet, anticoagulation	Relief of symptoms
9	Male	43	4 months	Abdominal pain and diarrhea	None	PE	Not reach the cecum; involvement of left colon and entire rectum; multifocal lesions; congestion, edema, fragileness, ecchymosis, hemorrhage, patchy erythema, erosion, ulceration, and stricture	IMV	Thrombosis, thrombophilia	Liquid diet, anticoagulation	Relief of symptoms
10	Male	46	7 months	Diarrhea	Hemorrhagic shock	DVT; membranous nephropathy	Not reach the cecum; involvement of both left and right colon, entire rectum; multifocal lesions; congestion, edema, fragileness, ecchymosis, erosion, ulceration, and stricture	SMV, IMV	Thrombosis	Liquid diet	Surgery due to hemorrhagic shock
11	Male	41	3 months	Diarrhea	None	DVT	Not reach the cecum; involvement of left colon and entire rectum; multifocal lesions; congestion, edema, fragileness, patchy erythema, erosion, ulceration, and stricture	SMV, IMV, PV	Thrombosis, thrombophilia	Liquid diet, anticoagulation	Relief of symptoms

PE: Pulmonary embolism; DVT: Deep vein thrombosis; HBP: Hypertension blood pressure; DM: Diabetes mellitus; IMV: Inferior mesenteric vein; SMV: Superior mesenteric vein; PV: Portal vein; CHD: Coronary heart disease; MCT: Medium-chain triglycerides.

Table 2 Computed tomography features in inferior mesenteric vein-related colon ischemia patients, n (%)

Characteristics	Patients (n = 11)
Involved bowel segments
Terminal ileum	2
Ascending colon	3
Transverse colon	6
Descending colon	8
Sigmoid colon	11
Rectum	9
Continuous lesions	11 (100)
Bowel wall thickening	11 (100)
Maximum thickness (mm), median (interquartile range)	13.5 (11.6-15.6)
Abnormal enhancement	10 (90.9)
Arterial phase
Attenuated	10 (90.9)
Enhanced	0
Unenhanced	1 (9.1)
Portal vein phase
Attenuated	4 (36.4)
Enhanced	1 (9.1)
Unenhanced	6 (54.5)
Luminal stenosis	9 (81.8)
Disappearance of the colonic haustration	10 (90.9)
Mesenteric exudation	10 (90.9)
Pneumatosis	0
Affected vessel
PV	5 (45.5)
SMV	4 (36.4)
IMV	11 (100)
Thrombus/embolus of IMV	0
Vascular opacification defect	10 (90.9)
Collateral circulation	8 (72.7)
Compensatory thickening of the arteries	9 (81.8)

PV: Portal vein; SMV: Superior mesenteric vein; IMV: Inferior mesenteric vein.

Table 3 Comparison of clinical characteristics of inferior mesenteric vein-related and arterial-related colon ischemia, n (%)/median (interquartile range)

Parameter	IMV-related CI (n = 11)	Arterial-related CI (n = 29)	P value
Sex (male)	11 (100)	18 (62.1)	0.019
Age (years)	44.5 (41.5-63.3)	66 (59.5-74)	0.064
Course (chronic)	11 (100)	16 (55.2)	0.007
HBP	4 (36.4)	12 (41.4)	1.000
CHD	1 (9.1)	4 (13.8)	1.000
DM	2 (18.2)	5 (17.2)	1.000
Smoking	5 (45.5)	9 (31.0)	0.469
Drinking	6 (54.5)	5 (17.2)	0.042
Abdominal pain	9 (81.8)	25 (86.2)	1.000
Diarrhea	9 (81.8)	22 (75.9)	1.000
Hematochezia	8 (72.7)	24 (82.8)	0.660
Tenesmus	8 (72.7)	7 (24.1)	0.009
Fever	1 (9.1)	12 (41.4)	0.068
Concurrent thrombosis	5 (45.5)	3 (10.3)	0.025
Emergency surgery	0	3 (10.3)	0.543
Poor prognosis	6 (54.5)	6 (20.7)	0.056
Laboratory test
WBC (× 109/L)	5.23 (4.07-6.37)	6.17 (4.62-8.36)	0.196
Hb (g/L)	130 (125-140)	111 (100-142)	0.175
Alb	36.0 (33.0-37.5)	35.0 (31.0-31.0)	0.473
hsCRP (mg/L)	9.96 (1.33-25.6)	15.9 (1.97-52.3)	0.664
ESR (mm/hour)	20.0 (9.00-36.8)	20.0 (18.0-44.0)	0.332
D-dimer (mg/L)	1.51 (0.89-3.15)	0.81 (0.49-2.50)	0.701
CT
Thickening	11 (100)	21 (72.4)	0.080
Stenosis	5 (45.5)	5 (17.2)	0.103
Dilation	1 (9.1)	3 (10.3)	1.000
Thrombus	0	1 (3.4)	1.000
Vascular opacification defect	8 (72.7)	0	< 0.001
Collateral circulation	9 (81.8)	2 (6.9)	< 0.001
Endoscopy
Cecum intubation	2 (18.2)	18 (62.1)	0.031
Right colon	4	16	1.000
Descending colon	4	20	0.596
Sigmoid colon	11	21	0.159
Proximal rectum (or upper rectum)	11	15	0.004
Distal rectum (or lower rectum)	10	7	< 0.001
Continuous lesions	10 (90.9)	21 (72.4)	0.399
Clear margins	0	12 (41.4)	0.017
Congestion and edema	11 (100)	29 (100)
Fragile	8 (72.7)	14 (48.3)	0.286
Ecchymosis, hematoma	2 (18.2)	2 (6.9)	0.300
Hemorrhage	1 (9.1)	1 (3.4)	0.479
Erosion	9 (81.8)	22 (75.9)	1.000
Stenosis	9 (81.8)	8 (27.6)	0.005
Endoscope unable to pass	3 (27.3)	4 (13.8)	0.369
Ulceration	6 (54.5)	18 (62.1)	0.727
Multifocal	5	16	1.000

IMV: Inferior mesenteric vein; CI: Colon ischemia; HBP: Hypertension blood pressure; CHD: Coronary heart disease; DM: Diabetes mellitus; WBC: White blood cell; Hb: Hemoglobin; Alb: Albumin; hsCRP: High-sensitivity C-reactive protein; ESR: Erythrocyte sedimentation rate; CT: Computed tomography.