# A rare case of abdominal pain and hematochezia: case report and literature review

## TL;DR

A rare case of abdominal pain and bleeding is reported, revealing a misdiagnosed condition called idiopathic myointimal hyperplasia of mesenteric veins.

## Contribution

This case report highlights the diagnostic challenges and histologic features of idiopathic myointimal hyperplasia of mesenteric veins (IMHMV).

## Key findings

- IMHMV was confirmed through histopathological evaluation showing intimal smooth muscle proliferation in mesenteric veins.
- The patient was initially misdiagnosed with ischemic colitis but later found to have IMHMV after surgical resection.
- Early recognition of IMHMV is crucial for refractory colonic ischemia cases.

## Abstract

Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare, non-thrombotic, non-inflammatory cause of chronic colonic ischemia, often misdiagnosed as inflammatory bowel disease (IBD) or ischemic colitis due to overlapping clinical features. We present the case of a 65-year-old man with progressive abdominal pain and hematochezia, initially treated as ischemic colitis without improvement. Surgical resection was eventually performed, and definitive diagnosis of IMHMV was established through histopathological evaluation, which revealed characteristic intimal smooth muscle proliferation in mesenteric veins. This report reviews the diagnostic challenges, histologic features, and clinical relevance of IMHMV, emphasizing the importance of early recognition and consideration of this entity in refractory colonic ischemia. Routine use of vascular imaging may help distinguish IMHMV from occult mesenteric arteriovenous malformations.