Ischemic Colitis Due to Idiopathic Myointimal Hyperplasia of the Mesenteric Veins

Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare and poorly understood noninflammatory ischemic colitis. First reported by Genta and Haggitt in 1991, the disease typically presents with chronic abdominal pain, weight loss, and diarrhea with or without hematochezia in middle-aged men. IMHMV is frequently misdiagnosed as an inflammatory bowel disease. The pathophysiology of IMHMV involves the proliferation of the intimal smooth muscle in mesenteric veins leading to bowel ischemia. The etiology of this process remains unknown. There are no good medical therapies for IMHMV, and surgical resection, a curative intervention, is typically required to make the diagnosis. We present the case of a 66-year-old man with IMHMV diagnosed with endoscopic biopsies.