Chronic antral ulcer associated with gastroduodenal lymphocytic phlebitis

Susan C. Abraham, Craig A. Solem, Stephen C. Hauser, Thomas C. Smyrk

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Enterocolic lymphocytic phlebitis (ELP) is a rare cause of gastrointestinal ischemia. Unlike most vasculitic diseases affecting the gastrointestinal tract, ELP involves only the mural and mesenteric veins, which are surrounded by a lymphocytic and sometimes granulomatous infiltrate. The mesenteric arterial system and the systemic vasculature are characteristically spared. Most patients with ELP present with an acute abdomen that resolves following surgical resection of the involved bowel. ELP has been reported to involve the small bowel, colon, or both, but involvement of the upper gastrointestinal tract has not been previously described. Here we report a case of lymphocytic phlebitis that affected only the stomach and duodenum. The patient, a 68-year-old man, had a nonhealing gastric antral ulcer and underwent hemigastrectomy with vagotomy and Billroth II reconstruction. Both the resected stomach and duodenum showed characteristic lymphocytic and granulomatous infiltrates that involved the submucosal and mural veins, with associated obliteration of vascular lumina; the adjacent arteries were completely spared. The patient developed late postoperative complications including bile reflux gastritis and erosive esophagitis, but he had no recurrence of gastrointestinal ulceration or ischemia over a 2-year follow-up. We hypothesize that there may be more cases of upper gastrointestinal ELP than are diagnosed as such, in part because the diagnosis can be made only on surgical resections specimens.

Original languageEnglish (US)
Pages (from-to)1659-1663
Number of pages5
JournalAmerican Journal of Surgical Pathology
Volume28
Issue number12
DOIs
StatePublished - Dec 1 2004

Keywords

  • Duodenum
  • Gastric ulcer
  • Granulomatous phlebitis
  • Lymphocytic phlebitis
  • Stomach

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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