SHM Converge Scientific Abstract ePoster Gallery-From Tea to Toxicity: Herbal Medicine-Induced Mesenteric Phlebosclerosis Requiring Colectomy

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A 32-year-old woman with no significant medical history presented with 3 days of severe diffuse abdominal pain, nausea, vomiting, obstipation, and abdominal distention. She had a very low BMI and reported recent use of a complex herbal tea mixture for constipation and energy, along with long-term intermittent herbal remedies for weight gain.<br /><br />Exam showed a thin, uncomfortable patient with abdominal distention, diffuse tenderness, and hypoactive bowel sounds. Labs were largely unremarkable except for mild hyponatremia, hypochloremia, and slight bilirubin elevation. CT abdomen/pelvis revealed classic serpiginous metallic densities/calcifications along the ascending, hepatic flexure, and transverse colon, along with small bowel obstruction and venous ischemic changes.<br /><br />She was initially treated with IV fluids and empiric antibiotics, but symptoms worsened. Diagnostic laparoscopy showed severely diseased, blackened colon with abscesses, prompting open right colectomy with end ileostomy and mucous fistula. She recovered well and was discharged with surgical follow-up.<br /><br />The final diagnosis was idiopathic mesenteric phlebosclerosis (IMP), a rare non-thrombotic ischemic colitis strongly associated with chronic herbal medicine use, particularly in Asian populations. CT is the key diagnostic test, often showing thread-like or serpiginous venous calcifications. Symptoms are nonspecific and may include abdominal pain, vomiting, diarrhea, or obstruction. Most cases can be managed conservatively by stopping the offending herbal products and providing bowel rest, but surgery is required for severe complications such as obstruction, hemorrhage, ischemia, or perforation.<br /><br />This case highlights the importance of asking about herbal supplement use in patients with unexplained gastrointestinal symptoms.

Asset Subtitle

Risheng Xu

Meta Tag

Author List Ali a Hashmi, Charles Trinh, Khawaja Azimuddin, Noorulaain Bhatti, Risheng Xu

Category Clinical Vignettes

Concept Idiopathic Mesenteric Phlebosclerosis

Concept Mesenteric Vein Calcification

Concept Ischemic Colitis

Concept Serpiginous Metallic Densities

Concept Herbal Medication

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Risheng Xu

Track Adult

Keywords

idiopathic mesenteric phlebosclerosis

herbal medicine use

ischemic colitis

abdominal pain

small bowel obstruction

venous calcifications

CT abdomen

colon ischemia

right colectomy

ileostomy

Idiopathic Mesenteric Phlebosclerosis

Mesenteric Vein Calcification

Ischemic Colitis

Serpiginous Metallic Densities

Herbal Medication