Objective:

To report a rare case of progressive acquired ileal mesenteric venous malformation developing after right hemicolectomy and to highlight its imaging findings and management.

Approach:

• Case Presentation: A 50-year-old woman presented with recurrent painless hematochezia and anemia four years after right hemicolectomy for colon cancer. Imaging revealed dilated veins in the ileal mesentery.
• Imaging Findings: Contrast-enhanced CT angiography showed clusters of tortuous veins with a caput medusae appearance, draining into the superior mesenteric vein and communicating with the lumbar vein.
• Surgical Intervention: Exploratory surgery confirmed a localized venous plexus, which was treated with targeted ligation and suturing, resulting in complete resolution of bleeding.

Key Findings:

• Acquired ileal mesenteric venous malformation can develop years after intestinal surgery.
• Imaging demonstrated progressive evolution of the venous malformation over time.
• Surgical intervention led to complete resolution of gastrointestinal bleeding.

Interpretation:

Acquired ileal mesenteric venous malformations should be considered in patients with unexplained delayed gastrointestinal bleeding post-surgery, as they may result from postoperative venous outflow alterations.

Limitations:

• The case is based on a single patient, limiting generalizability.
• Long-term follow-up data are limited to 58 months post-surgery.

Conclusion:

Acquired ileal mesenteric venous malformations may facilitate timely diagnosis and surgical management in similar cases.