Ischemic Colitis From Idiopathic Myointimal Hyperplasia of the Mesenteric Veins in a Post–Liver Transplant Patient

Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare cause of nonthrombotic, noninflammatory ischemic colitis. IMHMV classically presents in men with abdominal pain and bloody diarrhea and is frequently misdiagnosed as inflammatory bowel disease. However, IMHMV causes a more protracted, relapsing course of abdominal pain that does not respond to medical therapy. The diagnosis can be secured by colonoscopic biopsy. Surgical resection is curative and should be considered even in high-risk patients. Here, we describe a case of IMHMV diagnosed preoperatively in a post–liver transplant patient with residual portal hypertension who ultimately underwent successful surgical resection.