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EDITOR’S QUIZ: GI SNAPSHOT

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From question on page 460

The histological findings are characteristic of enterocolic lymphocytic phlebitis. This is a rare condition of unclear aetiology, exclusively involving the veins of the colonic wall and pericolic soft tissue. In this patient the cause of systemic vasculitis, including cryoglobulinaemia, was not found. Although intestinal vasculitis may occur in the context of systemic diseases such as systemic lupus erythematosus, polyarteritis nodosa, Churg-Strauss syndrome, Henoch-Schönlein purpura, and/or rheumatoid arthritis, isolated intestinal vasculitis is a rare event. It may appear in diseases such as Crohn’s disease where it primarily involves the arteries but not the veins. The isolated intestinal venulitis, better known as enterocolic lymphocytic phlebitis, is an uncommon cause of intestinal ischaemia recently described by Saraga and Costa.1 The disease is characterised by intestinal necrosis caused by a vasculitis restricted to the veins of the intestinal tract without involvement of arteries.1,2 On histological examination a wide variety of venous lesions are found but lymphocytic phlebitis is the most frequent lesion seen. In fig 1C, involvement of the vein with numerous lymphocytes is seen (arrowhead) whereas the artery (arrow) is uninvolved. Thrombotic obstruction may occur as a complication of the venous inflammation causing ischaemia and necrosis of the bowel.3 The aetiology and pathogenesis of this entity are unknown. None the less it has been speculated that lymphocyte mediated vascular damage linked to a hypersensitivity reaction may cause this type of vasculitis.3 In all reported series, patients had a favourable outcome without recurrence of intestinal ischaemia. To our knowledge this entity has not been reported in association with hepatitis C cirrhosis. Our patient recovered well and was discharged home one week after surgery.

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