Chronic antral ulcer associated with gastroduodenal lymphocytic phlebitis

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

Research output: Contribution to journalArticle

18 Citations (Scopus)

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 2004

Fingerprint

Phlebitis
Ulcer
Duodenum
Stomach
Ischemia
Bile Reflux
Gastroenterostomy
Mesenteric Veins
Acute Abdomen
Upper Gastrointestinal Tract
Esophagitis
Vagotomy
Gastritis
Stomach Ulcer
Blood Vessels
Gastrointestinal Tract
Antral
Veins
Colon
Arteries

Keywords

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

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Chronic antral ulcer associated with gastroduodenal lymphocytic phlebitis. / Abraham, Susan C.; Solem, Craig A.; Hauser, Stephen C.; Smyrk, Thomas Christopher.

In: American Journal of Surgical Pathology, Vol. 28, No. 12, 12.2004, p. 1659-1663.

Research output: Contribution to journalArticle

Abraham, Susan C. ; Solem, Craig A. ; Hauser, Stephen C. ; Smyrk, Thomas Christopher. / Chronic antral ulcer associated with gastroduodenal lymphocytic phlebitis. In: American Journal of Surgical Pathology. 2004 ; Vol. 28, No. 12. pp. 1659-1663.
@article{4eea400897b94e98ab67741ac01a47dd,
title = "Chronic antral ulcer associated with gastroduodenal lymphocytic phlebitis",
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.",
keywords = "Duodenum, Gastric ulcer, Granulomatous phlebitis, Lymphocytic phlebitis, Stomach",
author = "Abraham, {Susan C.} and Solem, {Craig A.} and Hauser, {Stephen C.} and Smyrk, {Thomas Christopher}",
year = "2004",
month = "12",
doi = "10.1097/00000478-200412000-00018",
language = "English (US)",
volume = "28",
pages = "1659--1663",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Chronic antral ulcer associated with gastroduodenal lymphocytic phlebitis

AU - Abraham, Susan C.

AU - Solem, Craig A.

AU - Hauser, Stephen C.

AU - Smyrk, Thomas Christopher

PY - 2004/12

Y1 - 2004/12

N2 - 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.

AB - 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.

KW - Duodenum

KW - Gastric ulcer

KW - Granulomatous phlebitis

KW - Lymphocytic phlebitis

KW - Stomach

UR - http://www.scopus.com/inward/record.url?scp=9444275988&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=9444275988&partnerID=8YFLogxK

U2 - 10.1097/00000478-200412000-00018

DO - 10.1097/00000478-200412000-00018

M3 - Article

C2 - 15577689

AN - SCOPUS:9444275988

VL - 28

SP - 1659

EP - 1663

JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

SN - 0147-5185

IS - 12

ER -