Colon (tumor & nontumor)
Other nonneoplastic
Idiopathic myointimal hyperplasia of mesenteric veins

Topic Completed: 1 May 2016

Revised: 9 January 2019, last major update May 2016

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Idiopathic myointimal hyperplasia of mesenteric veins

Raul S. Gonzalez, M.D.
Page views in 2019: 343
Page views in 2020 to date: 245
Cite this page: Gonzalez R. Idiopathic myointimal hyperplasia of mesenteric veins. website. Accessed August 10th, 2020.
Definition / general
  • Unusual thickening of mesenteric veins, resulting in gastrointestinal symptoms and ischemic colitis
Essential features
  • Rare condition that clinically mimics inflammatory bowel disease in young men
  • Thought to result from arteriovenous fistulization
  • Histology: hyperplastic veins mimic arteries (distinguish with elastin stain); thick walled vascular proliferation in mucosa
  • Usually (but not always) involves the left colon
Clinical features
  • Diarrhea / constipation, abdominal pain, rectal bleeding
Case reports
  • Surgery usually required
Clinical images

Images hosted on other servers:

Encircling ulcer on colonoscopy

Microscopic (histologic) description
  • Biopsy findings: ischemic mucosal change accompanied by proliferation of hyperplastic, thick walled, hyalinized blood vessels (Am J Surg Pathol 1996;20:1271)
  • Resection findings: mesenteric and mural veins show myointimal hyperplasia, making them somewhat resemble arteries; no vasculitis present; arteries are unaffected (Gastroenterology 1991;101:533)
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Dr. Raul S. Gonzalez:

Biopsy: mucosal
of thick walled

Resection: thickened
mural veins

High power: two
thickened veins
and one
unaffected artery

Elastin stain
internal elastic
lamina of artery

Images hosted on other servers:

Colonic ulceration
and thickened vein,
confirmed on
elastin stain

Positive stains
  • Elastin stain confirms that blood vessels with myointimal hyperplasia are veins, not arteries
Differential diagnosis
  • Inflammatory bowel disease: similar clinical picture but histology shows a classic chronic colitis, without vascular abnormalities
  • Mesenteric phlebosclerosis: unusual vascular disease seen only in Japanese patients; mesenteric and colonic mucosal vessels are calcified and sclerotic (Dis Colon Rectum 2003;46:209)
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